Biomedical subjects

Ann Marie McCarthy

Publications and source records attributed to Ann Marie McCarthy.

16 recordsLinked to original sources

PubMed2006

Predictors of topical anesthetic effectiveness in children.

UNLABELLED: Some children report significant pain with peripheral intravenous catheter (IV) insertion, despite the appropriate use of topical lidocaine anesthetics. This analysis of data from an existing study identified factors related to variation in topical anesthetic effectiveness used for IV insertion. The children (n = 218) in this investigation were 4 to 10 years old and undergoing a scheduled IV insertion. Inclusion criteria were (1) topical anesthetic was used according to manufacturer's recommendations, (2) DNA material was available, and (3) child completed a self-report measure of pain intensity (Oucher scale). Low pain phenotype was defined as a pain intensity score of 0 to 3, and high pain phenotype was an intensity score of 4 to 10. Potential predictor variables included child age, gender, number of previous painful procedures, state and trait anxiety, temperament characteristics, and alleles in 3 candidate genes in a pain pathway influenced by topical anesthetics (endothelin-1 [EDN1], endothelin receptor A [EDNRA], endothelin receptor B [EDNRB]). All subjects were genotyped for a single-nucleotide polymorphism in each gene. Children in the high pain group (n = 89) were significantly younger (P < .0001), more active (P = .0029), scored higher for trait (P = .0009) and state anxiety (P = .0312), and had the EDNRA TT genotype (high pain group, TT 67.35%; low pain group, TT 39.47%; P = .026). PERSPECTIVE: The identification of factors that influence peripheral pain sensation aids in selecting the most appropriate pharmacologic and nonpharmacologic interventions. Until genotyping is available at a clinically prescriptive level, other predictors (eg, age and activity level) can be used to tailor pain-relieving strategies for children undergoing needle sticks.

Administration, Topical↗

PubMed2006

Description of the methodology used in an ongoing pediatric care interventional study of children born with cleft lip and palate in South America [NCT00097149].

BACKGROUND: The contribution of birth defects, including cleft lip and palate, to neonatal and infant mortality and morbidity is substantial. As other mortality and morbidity causes including infections, hygiene, prematurity, and nutrition are eradicated in less developed countries, the burden of birth defects will increase proportionally. METHODS/DESIGN: We are using cleft lip and palate as a sentinel birth defect to evaluate its burden on neonatal and infant health and to assess the effectiveness of systematic pediatric care during the first month and first two years of life in decreasing this burden. The neonatal intervention, consisting of weekly pediatric evaluation and referral to appropriate care, is delivered to about 696 infants born with cleft lip and/or palate in 47 hospitals in South America. Neonatal mortality in this group will be compared to that in a retrospective control group of about 464 infants born with cleft lip and/or palate in the same hospitals. The subgroup of infants with isolated clefts of both the lip and palate (about 264) is also randomized into two groups, intervened and non-intervened, and further followed up over 2 years. Intervened cases are evaluated by pediatricians every three months and referred for appropriate care. The intervened and non-intervened cases will be compared over study outcomes to evaluate the intervention effectiveness. Non-intervened cases are matched and compared to healthy controls to assess the burden of cleft lip and palate. Outcomes include child's neurological and physical development and family social and economic conditions. DISCUSSION: Large-scale clinical trials to improve infant health in developing countries are commonly suggested, making it important to share the methods used in ongoing studies with other investigators implementing similar research. We describe here the content of our ongoing pediatric care study in South America. We hope that this may help researchers targeting this area to plan their studies more effectively and encourage the development of similar research efforts to target other birth defects or infant outcomes such as prematurity and low birth weight.

Cleft Lip↗

PubMed2006

PTSD and physical comorbidity among women receiving Medicaid: results from service-use data.

Patterns of physical comorbidity among women with posttraumatic stress disorder (PTSD) were explored using Michigan Medicaid claims data. PTSD-diagnosed women (n = 2,133) were compared with 14,948 randomly selected women in three health outcome areas: ICD-9 categories of disease, chronic conditions associated with sexual assault history in previous research, and reproductive health conditions. PTSD was associated with increased risk of all categories of diseases (OR range = 1.3-4.8), endometriosis (OR = 2.7), and dyspareunia (OR = 3.4). When PTSD was not complicated by other mental health conditions, odds ratios for chronic conditions ranged from 1.9 for fibromyalgia to 4.3 for irritable bowel. Comorbidity with depression or a dissociative or borderline personality disorder raised risk in a dose-response pattern.

Adolescent↗

PubMed2006

Strategies for salivary cortisol collection and analysis in research with children.

Salivary cortisol has emerged in pediatric research as an easy-to-collect, relatively inexpensive, biologic marker of stress. Cortisol is highly variable and is responsive to a wide range of factors that should be considered when incorporating this measure into research with children. Strategies for sample collection include: (1) standardizing the time for sample collection, including baseline samples; (2) using consistent collection materials and methods; (3) controlling for certain drinks, foods, medications, and diagnoses; and (4) establishing procedures and protocols. Other strategies for laboratory analyses include: (1) selecting the appropriate assay and laboratory; (2) identifying units of measure and norms; and (3) establishing quality controls. These strategies control extraneous variables and produce reliable and valid salivary cortisol results.

Bias↗

PubMed2006

A conceptual model of factors influencing children's responses to a painful procedure when parents are distraction coaches.

The purpose of this article is to present a model of factors that may influence a child's response to a painful procedure when parents are distraction coaches during the procedure. Nonpharmacological interventions, in particular, distraction, and parents as coaches for their children during procedures are discussed. A conceptual model is presented that illustrates the multiple factors and their possible relationships. A selected review of studies is provided that supports the inclusion of these factors in the model. The model and literature review focus on three major areas: characteristics of the child, characteristics of the parent, and procedural variables. The model presented is currently being tested in a large multisite study on the use of distraction during intravenous line insertion.

Attention↗

PubMed2006

Evaluating instruments for a study on children's responses to a painful procedure when parents are distraction coaches.

Existing research identifies numerous variables that may influence children's distress responses during medical procedures. In preparation for a large multisite study to test relationships among these numerous variables and parent distraction coaching, a pilot study of instruments was performed that measured the more complex constructs, namely anxiety, coping, temperament, attention, and parenting style. This article describes the benefits, process, and results of evaluating research instruments before initiating a large study on children's distress during ;medical procedures. A convenience sample of 68 children (4-12 years old) and their parents participated in this study. Children completed state and trait anxiety measures and a coping style scale. Parents completed questionnaires about their child's temperament, attention behavior, anxiety, and coping during a recent medical procedure, and about their own anxiety and parenting style. Coefficients of reliability of the measures were examined and understandability of the instruments was assessed. A forward regression showed that nurturing parenting style, parent's state anxiety, and child's state anxiety accounted for 32% of the variance in child distress during a recent medical procedure.

Attention↗

PubMed2006

Integrating molecular genetics analyses into clinical research.

The integration of molecular genetics approaches into the study of complex health phenomena is an increasingly important and available strategy for researchers across the health science disciplines. Pain sensation and response to painful stimuli are examples of complex health phenomena that are particularly amenable to molecular genetics approaches. Both human and animal model research suggests that differences in these responses may be related, in part, to variation in the genes that modulate sensation and behavior. The authors are currently managing a large cross-disciplinary research effort to identify child characteristics, including genotypes, that predict the degree of distress displayed by children following a painful medical procedure (i.e., IV insertion). The purpose of this article is to describe the strategies used to integrate molecular genetics methods into this project. The authors discuss the steps needed to complete this process, including (a) establishing a collaboration with genetics researchers and laboratory facilities, (b) developing and implementing a plan to manage biologic samples, and (c) incorporating genetics into the informed consent process.

Child↗

PubMed2006

Changes in medications administered in schools.

The purpose of this descriptive, cross-sectional study was to determine if there have been changes in the type and number of attention deficit/hyperactivity disorder (AD/HD) medications administered in schools since the introduction of long-acting stimulants. A survey was sent to 1,000 school nurses randomly selected from the National Association of School Nurses membership, with 339 returned (34%). Between 2000 and 2003 the proportion of students receiving any prescription medication (2.9/100 vs. 1.0/100), methylphenidate (1.2 vs. 0.2), or amphetamine/dextroamphetamine (0.3/100 vs. 0.1/100) was significantly reduced ( p < .0001). High school students took fewer prescription ( p < .0001) and AD/HD medications ( p < .0001), but more nonprescription medications than other students. A total of 163 different prescription medications and 28 nonprescription medications were administered during the typical school day. This study suggests that the use of long-acting stimulants has significantly reduced the number of prescription medications administered in schools. This reduction has been accompanied by a dramatic increase in the range of medications administered, making the medication administration process in schools more complex, not less.

Adolescent↗

PubMed2005

Evidence-based practice and school nursing.

School nurses need to demonstrate that their practice is based on the best evidence available, which is usually data obtained from research. Evidence-based practice involves combining the best evidence available with nursing expertise and patient and family preferences to determine optimum care. Evidence-based practice guidelines are developed by carefully reviewing the available evidence on a topic and synthesizing this information into recommendations for practice. This article defines evidence-based practice and best evidence, describes the development of evidence-based practice guidelines, discusses factors that affect the use of research and evidence-based practice guidelines in school nursing, and reviews current sources of evidence-based practice guidelines for school nurses. Strategies that school nurses can use to incorporate evidence into their practice are discussed. One recommendation is that school nurses partner with nurse leaders and nurse researchers to develop evidence-based practice guidelines relevant to school nurse practice.

Diffusion of Innovation↗

PubMed2005

Posttraumatic stress disorder and physical comorbidity among female children and adolescents: results from service-use data.

OBJECTIVE: In adults, posttraumatic stress disorder (PTSD) is associated with adverse health outcomes and high medical utilization and cost. PTSD is twice as common in women and is associated with increased risk for a range of diseases, chronic conditions, and reproductive-health problems. Little is known about the health effects of PTSD in children. The purpose of this study was to explore patterns of physical comorbidity in female children and adolescents with PTSD by using population data. METHODS: This study was a cross-sectional, descriptive epidemiologic case-control analysis of a Midwestern state's Medicaid eligibility and paid-claims data for girls (0-8 years old) and teens (9-17 years old). Data were from 1994-1997. All those with the PTSD diagnostic code were compared with randomly selected controls in relation to 3 sets of outcomes: (1) International Classification of Diseases, Ninth Revision (ICD-9) categories of disease; (2) chronic conditions previously associated with sexual trauma and PTSD in women; and (3) reproductive-health problems. Analyses included bivariate odds ratios (OR) and logistic-regression models that control for the extent of insurance coverage and the independent associations of victimization and psychiatric comorbidity with the 3 sets of outcomes. The mental health covariate was categorical to allow consideration of a range of severity. There were 4 categories for the young girls: neither PTSD nor depression, PTSD without depression, depression without PTSD, and PTSD + depression. For the adolescent analysis, a fifth category reflecting a "complex PTSD" was added, defined as having PTSD complicated by a dissociative disorder or borderline personality disorder diagnosis. RESULTS: There were 647 girls and 1025 adolescents with the PTSD diagnosis. Overall, PTSD was associated with adverse health outcomes in both age strata. Victimization was sometimes independently associated with adverse health outcomes, but PTSD often was a mediator, especially in the adolescent age stratum. The importance of PTSD diagnosis as a predictor of the ICD-9 categories of disease or chronic conditions seemed to increase with age. In the younger age stratum, the increased bivariate ORs of significant associations with PTSD ranged from 1.4 for digestive disorders to 3.4 for circulatory disorders. Among younger girls, PTSD diagnosis was associated with significantly greater bivariate odds for 9 of the 12 ICD-9 categories of disease but not for neoplasms, blood disorders, or respiratory disorders and with threefold increased odds for chronic fatigue. They also had 1.8 times greater odds for sexually transmitted infections, some of which could be from congenital transmission in this age group, which includes infants. In the multivariate models for the young girls, the mental health variable seemed to mediate the relationship between victimization and increased odds of infectious and parasitic diseases, endocrine/metabolic/immune disorders, circulatory diseases, skin and cutaneous tissue disorders, and having any 1 of the 5 chronic conditions. The mental health categories that were significantly associated with health outcomes varied across the conditions. There were no health outcomes in which the depression-without-PTSD category was the only one significantly associated with the outcome condition. Circulatory and musculoskeletal disorders were significantly associated with all 3 of the mental health categories. Having any 1 of the 5 chronic conditions was significantly associated only with simple PTSD (PTSD without depression). Genitourinary disorders and signs/symptoms/ill-defined conditions were significantly associated with both simple and comorbid PTSD. PTSD with comorbid depression, the most severe of the mental health categories in this younger age group, was the only category associated with the endocrine/metabolic/immune disorders and skin disorders outcomes. In the adolescent age stratum, the bivariate ORs significantly associated with PTSD ranged from 2.1 for blood disorders to 5.2 for irritable bowel syndrome. Adolescents with PTSD were nearly twice as likely to have a sexually transmitted infection and 60% more likely to have cervical dysplasia. However, their rate of pregnancy was lower (23% vs 31%), a one-fourth decreased odds. In the adolescent group, only 4 outcomes (nervous system/sense organ, digestive, and genitourinary disorders and signs/symptoms/ill-defined conditions) remained statistically significantly associated with victimization after the mental health variable was added, suggesting an additive model of risk for these outcomes but a mediating role for PTSD in relation to the majority of the health outcomes. Among the adolescent girls, the range of ORs for the ICD-9 and chronic-condition diagnoses generally increased across the categories of the mental health variable in a dose-response pattern. Compared with adolescents with neither PTSD nor depression, those with PTSD without depression had statistically significant ORs from 1.5 to 3.6. Those with depression without PTSD had statistically significant ORs from 1.9 to 4.4. The significant ORs for those with PTSD comorbid with depression were from 2.3 to 6.6, and those in the complex-PTSD category had significant ORs of between 2.5 and 14.9. Only blood disorders seemed to be more strongly associated with depression alone than with the comorbid and complex forms of PTSD. The simple-PTSD category was not significantly associated with blood disorders, chronic pelvic pain, fibromyalgia, or dysmenorrhea. Depression without PTSD was not significantly associated with chronic pelvic pain or fibromyalgia. Fibromyalgia was only significantly associated with complex PTSD. CONCLUSIONS: In young girls who receive Medicaid benefits, PTSD was associated with increased odds of a range of adverse health conditions. The pattern and odds of physical comorbidity among adolescent recipients with PTSD was nearly as extensive as that seen in adult women. Overall, the pattern observed suggests that objective disease states (eg, circulatory problems, infections) may be associated with PTSD to an extent nearly as great as that of PTSD with more subjective somatic experience of loss of wellness. Using the concepts of allostatic load and allostatic support, professionals who work with children and adolescents may be able to decrease the toll that traumatic stress takes on health even if available interventions can only be thought of as supportive and fall short of completely preventing trauma exposure or completely healing posttraumatic stress. Clinical research to extend these exploratory findings is warranted.

Adolescent↗

PubMed2003

Issues of medication administration and control in Iowa schools.

Who is responsible for medication administration at school? To answer this question, a descriptive, self-administered survey was mailed to a random sample of 850 school principals in Iowa. The eight-page, 57-item, anonymous survey was mailed first class, and a follow-up reminder post card was mailed two weeks later. Descriptive analyses were conducted, with type of respondent (principal versus school nurse), grade level, and size of school examined to explore differences. A 46.6% response rate was obtained; 97% of respondents indicated their schools had written guidelines for medication administration. Principals (41%) and school nurses (34%) reported that they have the ultimate legal responsibility for medication administration. Policies for medication administration on field trips were available in schools of 73.6% of respondents. High schools were more likely to allow self-medication than other grade levels. "Missed dose" was the most common medication error. The main reasons contributing to medication administration errors included poor communication among school, family, and healthcare providers, and the increased number of students on medication. It remains unclear who holds ultimate responsibility for medication administration in schools. Written policies typically exist for medication administration at school, but not field trips. Communicating medication changes to schools, and ensuring medications are available at school, likely can reduce medication administration errors.

Administrative Personnel↗

PubMed2003

School nurses' experiences with medication administration.

This article reports school nurses' experiences with medication administration through qualitative analyses of a written survey and focus groups. From a random sample of 1000 members of the National Association of School Nurses, 649 (64.9%) school nurses completed the survey. The quantitative data from the survey were presented previously. However, 470 respondents provided written comments on the survey. Comments on the eight items that had the most written comments were qualitatively analyzed. In addition, to clarify information obtained from the surveys, two focus groups with local school nurses were conducted. A constant comparative method of analysis was used, and results were combined from the two data sources. The combined analyses resulted in six final categories of concern: (a). delegation of medication administration, (b). comfort with delegation, (c). self-administration of medication, (d). medication administration errors, (e). storage of medication, and (f). administration policies. The findings suggest that school nurses across the country have similar concerns regarding the administration of medications in the school setting.

Clinical Nursing Research↗

PubMed2003

Factors associated with academic achievement in children with type 1 diabetes.

OBJECTIVE: To examine academic achievement in children with diabetes and to identify predictors of achievement. RESEARCH DESIGN AND METHODS: Participants were 244 children, ages 8-18 years, with type 1 diabetes. Measures included school-administered standardized achievement tests (Iowa Tests of Basic Skills and Iowa Tests of Educational Development [ITBS/ITED]), grade point averages (GPAs), school absences, behavioral assessment, age at disease onset, hospitalizations, and HbA(1c). Statistical differences between subgroups of children were evaluated using t test and ANOVA, statistically controlling for socioeconomic status. Regression analyses were carried out to examine predictors of academic performance. RESULTS: Reading scores and GPA were lower for children with poor metabolic control than for children with average control. Children with hospitalizations for hyperglycemia had lower overall achievement scores than children with better metabolic control and fewer hospitalizations for hyperglycemia. The small group of children with tight metabolic control and hypoglycemic hospitalizations scored particularly low on the ITBS/ITED. Other variables had less clear relationships with academic achievement. Neither early onset of diabetes nor frequent school absence was associated with lower scores on the ITBS/ITED. Sex comparisons found that boys performed better than girls only in math. Socioeconomic status and parent ratings of behavior problems were significantly correlated with academic achievement, but medical variables added only slightly to predictive precision. CONCLUSIONS: For most children with diabetes, medical variables are not as strongly associated with academic achievement as are factors such as socioeconomic status and behavioral factors. Poor metabolic control and serious hypoglycemia, however, are a potential concern for a subset of these children.

Achievement↗

PubMed2002

School nurses' experiences, concerns, and knowledge of growth disorders in children: development of a monograph.

Growth disorders may be associated with difficult psychosocial adjustment, learning problems, and specific health risks. Appropriate school health programming relies on school nurses who are skilled in growth assessment, management of psychosocial and behavioral problems, and effective communication with school personnel, children, families, and health care resources. A monograph and model individualized healthcare plans were developed for growth disorders in school-age children as an educational resource for school nurses. Knowledge of growth disorders among nurses receiving the monograph was evaluated in a random sample of 336 school nurses, members of the National Association of School Nurses. Knowledge of growth assessment and individualized health care plans for children with specific growth disorders was significantly higher in the group of school nurses who received the monograph. Specific obstacles to implementing school-based health care for children with growth disorders are discussed.

Adult↗

PubMed2002

A healthy lifestyle program: promoting child health in schools.

The problem of overweight children is an increasing public health concern in the United States. Many children today consume diets that are high in fat, lack regular physical activity, and receive minimal amounts of nutrition education at school. School-based education about nutrition and healthy lifestyles provides an opportunity for intervention with all children. A program for 4th- and 5th-grade students was designed to increase the student's knowledge about nutrition and healthy lifestyles. After implementation of the program, there was a significant increase in student knowledge of nutrition and healthy lifestyles as determined by a pretest and posttest evaluation. The results have implications for school nurses because childhood behaviors have such a profound impact on future adult lifestyle choices.

Child↗

PubMed2002

Effects of diabetes on learning in children.

OBJECTIVE: Subtle neuropsychological deficits have been found in some children with type 1 diabetes. However, these data have been inconsistent, and it is not clear what the impact of these deficits might be on the learning of children with diabetes over time. The purpose of this study was to determine whether type 1 diabetes significantly interferes with the development of functional academic skills. It was hypothesized that 1) children with type 1 diabetes would demonstrate deficits in academic performance and behavior when compared with sibling or classmate control subjects and 2) that academic performance in children with type 1 diabetes would decline slightly but significantly over time whereas the performance of siblings or classmates would not. METHODS: Three groups of children from 5 pediatric diabetes clinics in a primarily rural Midwestern state participated in this study: children with type 1 diabetes (n = 244), a sibling control group (n = 110), and an anonymous matched classmate control group (n = 209). The mean age of the children with diabetes was 14.8 years (standard deviation: 3.2) and of the siblings was 14.6 years (3.2); the mean grades were 8.1 (2.9) for the children with diabetes and 7.9 (3.1) for the siblings. The Hollingshead 2-factor index revealed that the children were from primarily middle- to upper-middle-class families. The mean age of onset of diabetes for the children with diabetes was 8.3 years (3.7) with a mean disease duration of 7.1 years (3.9). Because the matched classmate data were obtained anonymously, demographic information was not available on this group. Academic achievement was measured using both standardized tests and data on classroom performance. The standardized test data included scores from the Iowa Tests of Basic Skills (ITBS) for grades 3 through 8 and the Iowa Tests of Educational Development (ITED) for grades 9 through 12. Scores in 3 broad academic areas that are obtained on children of all ages were examined: math, reading, and core total (a composite score of reading, language, and math). ITBS/ITED data were obtained on all participants. School data including the number of days absent, school years repeated, and grade point averages for math and reading were obtained on the children with diabetes and their siblings. A short, 50-item screening scale (PBS-50d), adapted from the longer 165 item Pediatric Behavior Scale (PBS), was completed by the parents to obtain information on the behavioral characteristics of the children with diabetes and their siblings. Diabetes variables measured included metabolic control (HbA1c), age at onset, and disease duration. This study looked at both the current academic performance of children with diabetes and their performance over time in relation to 2 control groups: siblings and matched classmates. A cross-sectional approach was used to evaluate current performance. Statistical differences between groups were evaluated using matched t tests or McNemar's test for differences between related samples as appropriate. Differences across time were evaluated using hierarchical linear modeling. Comparisons of ITBS/ITED test scores across grades used national percentile ranks that were converted to standard scores (SS) with a mean of 100 and a standard deviation of 15. Students in this study performed above the national average, which is typical of students in the state where this study was conducted. Data from participating clinics were compared, and no differences in current achievement scores, grade point averages, or socioeconomic status were noted for either children with diabetes or their siblings. Therefore, all subsequent analyses used data combined from all sites. RESULTS: Current academic performance on the ITBS/ITED did not show lower performance by children with diabetes compared with either control group; in fact, children with diabetes performed better than their siblings on math (mean SS: 115.0 vs 111.1) and core total scores (mean SS: 113.9 vs 110.5) and better than their matched classmates on reading (mean SS: 108.9 vs 106.8). When subgroup comparisons based on diabetes metabolic control were made among children with diabetes, poorer academic performance tended to occur in children with poorer diabetic control. However, this pattern was also noted in sibling scores when the siblings were grouped on the basis of the level of diabetic control of their brother or sister with diabetes. Children with diabetes had significantly more school absences (Mean = 7.3 per year) than their siblings (M = 5.3) and more behavioral problems. Behaviorally, the 2 groups did not differ on the 4 general factors of Aggression/Opposition, Hyperactivity/Inattention, Depression/Anxiety, and Physical Complaints. However, children with diabetes did differ significantly from their siblings on items that reflected compliance, mood variability, and fatigue, but not learning. These were 4 areas included in the PBS-50d to reflect potential concerns for children with diabetes. Academic achievement growth curves for the ITBS/ITED for each group revealed no statistically significant differences between groups when tested using hierarchical linear modeling. Individual differences in the growth trajectories were too small and inconsistent to be detected. CONCLUSIONS: For most children, type 1 diabetes is not associated with lower academic performance compared with either siblings or classmates, although increased behavioral concerns are reported by parents. The results of this study suggest that the subtle cognitive deficits often documented in children with type 1 diabetes may not significantly limit the functional academic abilities of these children over time. However, careful monitoring is still needed to ensure that episodes of hypoglycemia associated with seizures are not adversely affecting learning.

Adolescent↗