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Biomedical subjects

Dennis Drotar

Publications and source records attributed to Dennis Drotar.

At least 37 records · Page 2Linked to original sources
PubMed2005

Enhancing parent-provider communication in ambulatory pediatric practice.

OBJECTIVE: To address the need for interventions to enhance parent-provider communication, the present study evaluated the effectiveness of a brief intervention to enhance interpersonal communication skills by pediatric and internal medicine/pediatric residents with parents of children seen in ambulatory practice. METHODS: In a within-subjects, repeated measures research design, residents (N=28) participated in a 1-112h intervention designed to increase the use of effective communication skills with their patients' families (N=92). Three pediatric visits (one prior to and two following the intervention) were audio-taped and coded using Roter's Interaction Analysis System. Parents' perceptions of residents' communication skills and satisfaction with care were gathered. RESULTS: Residents used more effective interpersonal communication skills following the intervention (p<.05). Parent satisfaction with care also increased (p<.01) with parents reporting greater satisfaction with distress relief (p=.01) and communication following the intervention (p=.05). However, parents' perceptions of resident communication did not change over time. CONCLUSION: These findings suggest that a relatively brief intervention shows promise in improving the quality of care provided within a pediatric ambulatory care setting. PRACTICE IMPLICATIONS: Training residents to increase their use of praise, empathy, and collaboration with families can be done within a brief intervention and may be associated with increased parental satisfaction with care.

Adult↗
PubMed2005

Longitudinal relationships of depressive symptoms to pain intensity and functional disability among children with disease-related pain.

OBJECTIVE: To examine the longitudinal relationship between depressive symptoms at study entry (T1) on pain intensity (PI) and functional disability over a 1-year period among children with either sickle cell disease (SCD) or juvenile idiopathic arthritis (JIA). METHODS: 119 children, ages 8-17 years, completed measures of depression at T1 as well as pain and functional disability at T1, 6-month (T2), and 12-month (T3) follow-ups. Caregivers also rated their child's pain and disability at each time point. General linear mixed modeling was employed to examine longitudinal relationships between study variables. RESULTS: For children with JIA, T1 pain significantly moderated the effects of T1-depressive symptoms on T2 and T3 pain where T1-depressive symptoms predicted future child-reported pain only when T1 pain was relatively mild. Similarly, T1-depressive symptoms predicted future child-reported disability only when initial reports of disability were relatively low. Only family income significantly predicted T2 and T3 pain in children with SCD. CONCLUSIONS: Study findings suggest that T1-depressive symptoms play a role in the longitudinal course of pain symptoms in children with JIA but not in children with SCD.

Activities of Daily Living↗
PubMed2005

Long-term parental and family adaptation following pediatric brain injury.

OBJECTIVE: To determine whether parents of children with traumatic brain injuries (TBI) report increased injury-related burden, distress, and family dysfunction and to examine the effects of attrition on the results. METHODS: Children with severe TBI, moderate TBI, and orthopedic injuries were followed at six time points from baseline to 6 years after injury. Parents completed measures of injury-related burden, psychological distress, and family functioning at each assessment. Mixed model analysis was used to examine long-term changes. RESULTS: Attrition was higher among families in the severe TBI group with lower burden thereby amplifying group differences. The severe TBI group reported higher injury-related burden over time after injury than the other groups. Family functioning was moderated by social resources. Families of children with severe TBI and low resources reporting deteriorating functioning over the follow-up interval. CONCLUSIONS: Although environmental advantages moderate long-term effects on family functioning, families of children with severe TBI experience long-standing injury-related burden.

Adaptation, Psychological↗
PubMed2005

Benchmarks for work performance of pediatric psychologists.

OBJECTIVE: To establish benchmarks for work performance of pediatric psychologists. METHODS: All full members of the Society of Pediatric Psychology, Division 54 of the American Psychological Association (N = 1043), were recruited for participation in a mail survey. Four hundred and seventy surveys were returned (45%); 356 usable surveys (34%) were included in the analyses. Surveys assessed work-settings, academic appointments, salary, performance expectations and evaluations, and satisfaction. RESULTS: Most of the survey respondents, 63%, worked in a hospital setting. On average, survey respondents were directly accountable for generating half, 52%, of their salary. Salary covered by institutions was most frequently provided for nonrevenue generating activities such as administration and teaching. Most of the sample (78%) indicated clear performance expectations and criteria. CONCLUSIONS: Findings update and expand previously established benchmarks for work performance and have implications for the practice of pediatric psychology in an ever-changing health care environment.

Academic Medical Centers↗
PubMed2005

Chronic conditions, functional limitations, and special health care needs of school-aged children born with extremely low-birth-weight in the 1990s.

CONTEXT: Information on the school-age functioning and special health care needs of extremely low-birth-weight (ELBW, <1000 g) children is necessary to plan for medical and educational services. OBJECTIVE: To examine neurosensory, developmental, and medical conditions together with the associated functional limitations and special health care needs of ELBW children compared with normal-birth-weight (NBW) term-born children (controls). DESIGN, SETTING, AND PARTICIPANTS: A follow-up study at age 8 years of a cohort of 219 ELBW children born 1992 to 1995 (92% of survivors) and 176 NBW controls of similar sociodemographic status conducted in Cleveland, Ohio. MAIN OUTCOME MEASURES: Parent Questionnaire for Identifying Children with Chronic Conditions of 12 months or more and categorization of specific medical diagnoses and developmental disabilities based on examination of the children. RESULTS: In logistic regression analyses adjusting for sociodemographic status and sex, ELBW children had significantly more chronic conditions than NBW controls, including functional limitations (64% vs 20%, respectively; odds ratio [OR], 8.1; 95% confidence interval [CI], 5.0-13.1; P<.001), compensatory dependency needs (48% vs 23%, respectively; OR, 3.0; 95% CI, 1.9-4.7; P<.001), and services above those routinely required by children (65% vs 27%, respectively; OR, 5.4; 95% CI, 3.4-8.5; P<.001). These differences remained significant when the 36 ELBW children with neurosensory impairments were excluded. Specific diagnoses and disabilities for ELBW vs NBW children included cerebral palsy (14% vs 0%, respectively; P<.001), asthma (21% vs 9%; OR, 3.0; 95% CI, 1.6-5.6; P = .001), vision of less than 20/200 (10% vs 3%; OR, 3.1; 95% CI, 1.2-7.8; P = .02), low IQ of less than 85 (38% vs 14%; OR, 4.5; 95% CI, 2.7-7.7; P<.001), limited academic skills (37% vs 15%; OR, 4.2; 95% CI, 2.5-7.3; P<.001), poor motor skills (47% vs 10%; OR, 7.8; 95% CI, 4.5-13.6; P<.001), and poor adaptive functioning (69% vs 34%; OR, 6.5; 95% CI, 4.0-10.6; P<.001). CONCLUSION: The ELBW survivors in school at age 8 years who were born in the 1990s have considerable long-term health and educational needs.

Child↗
PubMed2005

Posttraumatic stress and related impairment in survivors of childhood cancer in early adulthood compared to healthy peers.

OBJECTIVE: To compare rates of posttraumatic stress disorder (PTSD) and related impairment between childhood cancer survivors in early adulthood and healthy peers. METHODS: Cancer survivors (n = 57) and comparison group (n = 83) completed measures of PTSD, depression, health-related quality of life (HRQOL), mood, and satisfaction with life (SWL). RESULTS: The cancer survivor group was more likely to have PTSD than the control group (odds ratio = 4.67, p < .05) but was not more likely to experience subclinical PTSD symptoms. The groups differed on physical HRQOL, F(1, 140) = 15.02, p < .001, and positive affect, F(1, 140) = 7.03, p < .01, but did not differ on depression, SWL, psychosocial HRQOL, and negative mood. Those in the survivor group with PTSD (n = 10) experienced more depression and negative affect, worse HRQOL and SWL, perceived their cancer to impact developmental tasks more, and were older at the time of diagnosis compared with those without PTSD (n = 47). CONCLUSIONS: Although most are well adjusted, childhood cancer survivors in early adulthood are more likely to have PTSD and to experience significant impairment compared with healthy peers.

Adaptation, Psychological↗
PubMed2005

Factor structure of the child health questionnaire-parent form in pediatric populations.

OBJECTIVE: To conduct separate exploratory factor analyses (EFA) and confirmatory factor analyses (CFA) of the Child Health Questionnaire-Parent Form 50 (CHQ-PF-50) with a sample of children and adolescents with chronic conditions and physically healthy children seen in a pediatric setting. METHOD: Parents of 329 children with chronic conditions including cancer, epilepsy, recurrent headache, inflammatory bowel disease (IBD), juvenile rheumatoid arthritis (JRA), sickle cell disease (SCD), and recurrent sleep disturbance and 332 physically healthy children completed CHQ-PF-50. RESULTS: The EFA yielded a 27-item measure with seven factors for children with chronic conditions and a 28-item measure with eight factors for physically healthy children. Structural equation modeling procedures were used to conduct a second order CFA, which yielded the secondary factors of physical health and psychosocial health. A CFA yielded an excellent fit to the data for each group, but the models were different for each group. CONCLUSIONS: CFA-derived models of the CHQ-PF-50 demonstrated construct validity for measuring the latent constructs of physical and psychosocial health in children and adolescents with chronic conditions and physically healthy children and adolescents. However, somewhat different factor solutions emerged for each group, suggesting that the specific domains assessed by the CHQ-PF-50 were not equivalent across groups. Findings have implications for applications of the CHQ-PF-50.

Adolescent↗
PubMed2005

Clinician-parent communication during informed consent for pediatric leukemia trials.

OBJECTIVE: To address the need to describe informed consent in pediatric settings and to identify barriers to parent understanding, this study assessed how aspects of clinician-parent communication during the informed consent conference (ICC) relate to parent understanding of informed consent and parent perception of the impact of the ICC on their anxiety and control. METHODS: Parents of 127 children with newly diagnosed leukemia who were eligible for clinical trials were the participants. The study used comprehensive methods including both observational and self-report assessment methods. RESULTS: Structural equation modeling demonstrated that parent race and socioeconomic status (SES) were powerful predictors of clinician-parent communication, parent anxiety and control as a result of the ICC, and parent understanding. Clinician information giving and partnership building predicted parent participation during the ICC. CONCLUSIONS: These findings may be used to design interventions that increase the effectiveness of the ICC by identifying specific elements of the conference that influence parent affect and understanding.

Adolescent↗
PubMed2005

A randomized controlled trial for the primary prevention of osteoporosis among preadolescent girl scouts: 1-year outcomes of a behavioral program.

OBJECTIVE: To provide 1-year outcomes for a randomized controlled trial of a behavioral-educational intervention for the primary prevention of osteoporosis among 247 preadolescent girls. METHODS: Girl Scout troops were randomly assigned to one of two intervention groups-a group comprising girls only (n = 73) and girls with their mothers (n = 94)-and a healthy-lifestyles control group (n = 80). Multilevel (hierarchical) models were employed to account for clustering of girls within troops. RESULTS: Among girls who met the recommended levels of Ca at baseline, those in the intervention were significantly more likely to maintain or improve their intake at follow-up compared to controls. No significant group differences were found for changes in WBPA. CONCLUSIONS: A behavioral intervention for the primary prevention of osteoporosis holds promise for maintaining adequate Ca intake among preadolescent females.

Calcium, Dietary↗
PubMed2005

Effects of the home environment on school-aged children's sleep.

STUDY OBJECTIVE: Examine the relationship between the sleep behavior of elementary school-aged children and characteristics of the home environment. DESIGN: Cross-sectional analysis of children participating in a cohort study. SETTING: Cleveland Children's Sleep and Health Study, an ethnically mixed, urban, community-based cohort. PARTICIPANTS: Four hundred forty-nine children (50% girls, 46% African-American) aged 8 to 11 years. MEASUREMENTS AND RESULTS: Sleep and health data were obtained from a child-completed 7-day sleep journal and caregiver-completed health and sleep questionnaire. Home-environment predictors were Middle-Childhood Home Observation for Measurement of the Environment (MC-HOME) total score and Encouragement of Maturity and Physical Environment subscale scores. Sleep outcomes were mean nightly sleep duration, night-to-night variation in sleep duration, and bedtime of 11 PM or later. Adjusted analyses showed that higher Encouragement of Maturity subscale scores were associated with longer sleep duration (P < .05) and decreased odds of a bedtime at 11 PM or later (odds ratio = .74, 95% confidence interval, .58-.95). In girls, higher Encouragement of Maturity scores were also associated with decreased nightly variation in mean sleep duration (P < .001). Increases in total MC-HOME score were associated with increased mean sleep duration among African-American children only (P < .05). CONCLUSION: Collectively, results indicate that a parenting style encouraging social maturity in children is linked to healthier sleep patterns.

Child↗
PubMed2005

Long-term attention problems in children with traumatic brain injury.

OBJECTIVE: To examine long-term attention problems and their cognitive correlates after childhood traumatic brain injury (TBI). METHOD: Data were drawn from a prospective, longitudinal study conducted between 1992 and 2002. Participants included 41 children with severe TBI, 41 with moderate TBI, and 50 with orthopedic injury (OI), who were all between 6 and 12 years of age at the time of injury. Parent ratings of attention problems were obtained at a long-term follow-up on average 4 years post-injury and compared with ratings of premorbid attention problems obtained shortly after injury. At the long-term follow-up, children also completed several cognitive tests of attention and executive functions. RESULTS: Hierarchical linear and logistic regression analyses indicated that the severe TBI group displayed significantly more attention problems than the OI group at 4 years post-injury, both behaviorally and cognitively, after controlling for race, socioeconomic status, and premorbid attention problems. At long-term follow-up, 46% of the severe TBI group displayed significant attention problems on the Child Behavior Checklist, as opposed to 26% of the OI group (odds ratio=3.38; 95% confidence interval, 1.15-9.94). On the Attention-Deficit/Hyperactivity Disorder Rating Scale, 20% of the severe TBI group displayed clinically significant attention problems compared with 4% in the OI group (odds ratio=9.59; 95% confidence interval, 1.24-73.99). However, group differences in behavioral symptoms were significantly larger for children with more premorbid symptoms than for children with fewer premorbid problems. Measures of executive functions were significantly related to behavioral attention problems, after controlling for group membership, race, and socioeconomic status. CONCLUSIONS: Childhood TBI exacerbates premorbid attention problems. Long-term behavioral symptoms of attention problems are related to the cognitive deficits in attention and executive functions that often occur in association with childhood TBI.

Attention Deficit Disorder with Hyperactivity↗
PubMed2005

Psychometric properties of the Pediatric Emotional Distress Scale in a diverse sample of children exposed to interpersonal violence.

This study determined psychometric properties of the Pediatric Emotional Distress Scale (PEDS) with an ethnically diverse sample of 383 children 2 to 7 years of age exposed to interpersonal violence and participating in a community-based intervention. Means and alpha coefficients for the total scale and 3 subscales fell within previously reported parameters. Separate exploratory factor analysis and confirmatory factor analysis using structural equation modeling revealed that compared to the PEDS's 3-factor structure (Anxious/Withdrawn, Fearful, Act Out), a modified PEDS model with 2 latent factors (Act Out and Internalize) better fit the data and also held for both African American and White subsamples. Different correlations between the two factors and the Revised Behavior Problem Checklist further suggested that the factors represented unique latent constructs and gave evidence of construct validity. The modified PEDS could potentially be used for screening children exposed to violence.

Affective Symptoms↗
PubMed2005

Poor predictive validity of the Bayley Scales of Infant Development for cognitive function of extremely low birth weight children at school age.

OBJECTIVE: The Bayley Scales of Infant Development, Second Edition (BSID II) are commonly used to assess outcomes of extremely low birth weight (ELBW) infants. We sought to assess the predictive validity of the BSID II Mental Developmental Index (MDI) for cognitive function at school age. DESIGN/METHODS: Of 330 ELBW infants admitted in 1992-1995, 238 (72%) survived to the age of 8 years, of whom 200 (84%) were tested at both 20 months' corrected age (CA) and 8 years. Mean birth weight was 811 g, mean gestational age was 26.4 weeks, 41% were boys, and 60% were black. Measures included the BSID II at 20 months' CA and the Kaufman Assessment Battery for Children (KABC) Mental Processing Composite (MPC) at 8 years' postnatal age. BSID II MDI and MPC scores were compared and the predictive validity calculated for all 200 ELBW children and for the 154 ELBW neurosensory-intact subgroup. Predictors of stability or change in cognitive scores were examined via logistic regression adjusting for gender and sociodemographic status. RESULTS: For all ELBW children, the mean MDI was 75.6 +/- 16 versus a mean KABC of 87.8 +/- 19. For the neurosensory-intact subgroup, the mean MDI was 79.3 +/- 16 and the mean KABC was 92.3 +/- 15. Rates of cognitive impairment, defined as an MDI or KABC of <70, dropped from 39% at 20 months' CA to 16% at 8 years for the total ELBW population and from 29% to 7% for the neurosensory-intact subgroup. The positive predictive value of having an MPC of <70 given an MDI of <70 was 0.37 (95% confidence interval [CI]: 0.27, 0.49) for all ELBW infants, 0.20 (95% CI: 0.10, 0.35) for the neurosensory-intact subgroup, and 0.61 (95% CI: 0.42, 0.77) for the neurosensory-impaired subgroup. The negative predictive values were 0.98, 0.99, and 0.85 for the 3 groups, respectively. Neurosensory impairment at 20 months' CA predicted lack of improvement of cognitive function (odds ratio: 6.9; 95% CI: 2.4, 20.2). Children whose cognitive scores improved between 20 months and 8 years had significantly better school performance than those whose scores stayed at <70, but they did less well than those whose scores were persistently >70. CONCLUSIONS: The predictive validity of a subnormal MDI for cognitive function at school age is poor but better for ELBW children who have neurosensory impairments. We are concerned that decisions to provide intensive care for ELBW infants in the delivery room might be biased by reported high rates of cognitive impairments based on the use and presumptive validity of the BSID II MDI.

Blindness↗
PubMed2004

Communication of randomization in childhood leukemia trials.

CONTEXT: Most children diagnosed as having leukemia become research subjects in randomized clinical trials (RCTs), but little is known about how randomization is explained to or understood by parents. OBJECTIVE: To investigate physicians' explanation and parental understanding of randomization in childhood leukemia RCTs. DESIGN AND SETTING: A multisite study of the informed consent communication process for RCTs of childhood leukemia. Consecutive cases were recruited from pediatric oncology inpatient wards at 6 US children's hospitals associated with major academic medical centers from July 1, 1999, until December 31, 2001. The informed consent conferences were observed and audiotaped, and the information obtained was coded and analyzed. Parents were interviewed shortly after the conference to ascertain their understanding. PARTICIPANTS: Parents and members of the health care team who participated in 137 informed consent conferences for children with newly diagnosed acute leukemia. MAIN OUTCOME MEASURES: Observed explanations of randomization and parental understanding of randomization after the consent conference. RESULTS: Randomization was explained by physicians in 83% of cases and a consent document was presented during the conference in 95% of cases. Interviews after the conference demonstrated that 68 (50%) of 137 parents did not understand randomization. Parents of racial minority and lower socioeconomic status were less likely to understand randomization (P<.001 for each). Discussion of specific clinical trial details and the presence of a nurse during the conference were associated with understanding. Eighty-four percent of children were enrolled in a leukemia trial. CONCLUSIONS: Despite oral and written explanation, half of the parents in this study did not understand randomization for childhood leukemia trials. To make informed consent more effective, future research must seek to improve communication during this critical interchange.

Adolescent↗