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Biomedical subjects

Dennis Drotar

Publications and source records attributed to Dennis Drotar.

At least 55 records · Page 3Linked to original sources
PubMed2004

Sleep behavior in an urban US sample of school-aged children.

OBJECTIVES: To describe sleep behavior of elementary school-aged children and to assess variations by age, sex, and ethnicity. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional analysis of 755 (50% female, 35% ethnic minority) children 8 to 11 years old from a community-based sample of children participating in a cohort study. Sleep and health data were obtained from a child-completed 7-day sleep journal and a caregiver-completed health/sleep questionnaire. MAIN OUTCOME MEASURE: Mean nightly sleep duration; bedtime 11 pm or later. RESULTS: Mean (SD) sleep duration for all children was 9.63 (0.72) hours. Univariate results showed a statistically significant decrease in mean sleep duration associated with increasing age (P < .001) and male sex (P = .03). At all ages, minority boys slept significantly less than nonminority boys and girls and minority girls. The shortest covariate-adjusted mean sleep duration was observed among the oldest minority boys (9.28 [0.07] hours vs 9.43-9.85 hours in the other age, sex, and ethnicity subgroups). Forty-three percent of 10- to 11-year-old minority boys reported less than 9 hours nightly sleep vs 5% to 26% of the other age, sex, and ethnicity subgroups. After controlling for potential confounding, minority children were more likely than nonminority children to have a bedtime of 11 pm or later (odds ratio, 4.8; 95% confidence interval, 2.9-8.0). CONCLUSIONS: A sizeable proportion of elementary schoolchildren sleep less than the recommended 9 hours. Across the age range, decreases in sleep time and, in ethnic minorities, increasingly delayed bedtimes suggest emerging sleep restriction in preadolescents. Observed ethnic differences in sleep behavior highlight the need for better understanding of the social and environmental influences encouraging these sleep patterns.

Age Factors↗
PubMed2004

Health-related quality of life of children with primary immunodeficiency disease: a comparison study.

BACKGROUND: Many symptoms of primary immunodeficiency (PI) disease can be successfully managed with intravenous immunoglobulin infusion. Although survival rates and prognosis have greatly improved, children with PI disease are still at risk for physical, social, and psychological problems owing to their chronic health condition. However, to our knowledge, there are no empirical data concerning health-related quality of life (HRQOL) in children with PI disease receiving intravenous immunoglobulin infusion. OBJECTIVE: To compare parental reports of HRQOL of children with PI disease receiving intravenous immunoglobulin infusion with children with juvenile idiopathic arthritis (JIA) and a healthy sample. METHODS: Demographic, illness, and HRQOL data were collected from parents of 4- to 18-year-old children with PI disease (n = 36), children with JIA (n = 36), and healthy children (n = 36). The HRQOL was evaluated using the Child Health Questionnaire-Parent Report version. RESULTS: Compared with children with JIA, children with PI disease were similar in many aspects of their HRQOL. However, parents of children with PI disease reported greater limitations in their personal time, poorer general health of their children, greater limitations in their children's physical functioning and family activities, and less bodily pain than children with JIA. In contrast, children with PI disease scored lower on most HRQOL domains compared with healthy children. CONCLUSION: Children with PI disease experience similar HRQOL to children with JIA and poorer HRQOL than healthy children, indicating potential areas to be addressed by future medical and psychosocial interventions.

Adolescent↗
PubMed2004

Short- and long-term social outcomes following pediatric traumatic brain injury.

The social outcomes of pediatric traumatic brain injury (TBI) were examined in a prospective, longitudinal study that included 53 children with severe TBI, 56 with moderate TBI, and 80 with orthopedic injuries, recruited between 6 and 12 years of age. Child and family functioning were assessed at baseline, at 6- and 12-month follow-ups, and at an extended follow-up a mean of 4 years post injury. Growth curve analyses revealed that pediatric TBI yields negative social outcomes that are exacerbated by family environments characterized by lower socioeconomic status, fewer family resources, and poorer family functioning. After controlling for group membership, age, race, socioeconomic status, and IQ, path analyses indicated that long-term social outcomes were accounted for in part by specific neurocognitive skills, including executive functions and pragmatic language, and by social problem-solving. Deficits in these domains among children with TBI are likely to reflect damage to a network of brain regions that have been implicated in social cognition.

Adaptation, Psychological↗
PubMed2004

Interpersonal stressors and resources as predictors of parental adaptation following pediatric traumatic injury.

The authors examined the relationship of preinjury interpersonal resources and stressors to parental adaptation following pediatric traumatic brain injury (TBI) and orthopedic injury. Parents of children with severe TBI (n = 53), moderate TBI (n = 56), and orthopedic injuries (n = 80) were assessed soon after injury, 6 and 12 months after the initial evaluation, and at an extended follow-up with a mean of 4 years postinjury. General linear model analyses provide support for both main and moderating effects of stressors and resources on parental adjustment. Support from friends and spouse was associated with less psychological distress, whereas family and spouse stressors were associated with greater distress. The results also reveal a marked decline in injury-related stress over follow-up for families in the severe TBI group who reported a combination of high stressors and high resources. The decline suggests that interpersonal resources attenuated long-term family burden because of severe TBI. The findings are discussed in terms of their implications for intervention following TBI.

Adaptation, Psychological↗
PubMed2004

Effects of written emotional disclosure on caregivers of children and adolescents with chronic illness.

OBJECTIVE: Tested feasibility of a written emotional disclosure intervention with caregivers of youths with chronic illness and its effects on measures of mood, physical symptoms, health-related quality of life, distress, and caregiver appraisal of stress and efficacy. METHODS: Measures were administered prior to and immediately after writing and 4 months later. Experimental group (n = 29) wrote about traumas and stressors while the control group (n = 25) wrote about summer activities for 20 minutes on three different days. RESULTS: Consistent with hypotheses, the experimental group experienced less positive affect, F(1, 54) = 4.68, p <.05, and more negative affect, F(1, 54) = 7.92, p <.01, and physical symptoms, F(1, 54) = 4.30, p <.05, immediately following writing than the control group. There were no significant Group x Time interactions on long-term mood, distress, health-related quality of life, or caregiver appraisal. Contrary to hypotheses, the control group had more vitality over time, F(1, 53) = 21.29, p <.001, than the experimental group. CONCLUSIONS: Recommendations include modifying the procedures to attain more control in applied settings and identifying specific processes that contribute to the efficacy of written emotional disclosure on well-being.

Adolescent↗
PubMed2004

Correlates of parental participation during informed consent for randomized clinical trials in the treatment of childhood leukemia.

This study described parent participation in the informed consent conference for randomized clinical trials (RCTs) in childhood leukemia and documented the relationship of physician communication to parent participation. Parents of 140 children with newly diagnosed leukemia who were eligible for RCTs were studied at six sites using comprehensive methods involving direct observation and transcripts of parent-physician communication based on audiotapes. Parent participation during the informed consent conference reflected a wide range of content categories. Consistent with hypotheses, Physician Rapport and Partnership Building related to parent participation in the informed consent conference but Information Giving did not. Higher parent socioeconomic status also was related to greater parent participation for two of the three measures of parent participation. Findings suggest that physician behaviors that provide support and facilitate communication may enhance parental participation in the informed consent conference for RCTs in childhood leukemia.

Child↗
PubMed2004

Children's competence for assent and consent: a review of empirical findings.

This narrative review summarizes the empirical literature on children's competence for consent and assent in research and treatment settings. Studies varied widely regarding methodology, particularly in the areas of participant sampling, situational context studied (e.g., psychological versus medical settings), procedures used (e.g., lab-based vs. real-world approaches), and measurement of competence. This review also identifies several fundamental dilemmas underlying approaches to children's informed consent. These dilemmas, including autonomy versus best interest approaches, legal versus psychological or ethical approaches, child- versus family-based approaches, and approaches that emphasize consent versus those that emphasize assent, have implications for the measurement of children's competence and interpretation of findings. Recommendations for future research in the area of children's informed consent include the use of diverse samples and control groups, development of multidimensional and standardized measures of competence, utilization of multidimensional and standardized measures of competence, utilization of observational methods and longitudinal designs, examination of noncognitive aspects of children's competence and comparison of children's competence for treatment and research decisions.

Adolescent↗
PubMed2004

How do primary care physicians manage children with possible developmental delays? A national survey with an experimental design.

OBJECTIVE: Although early detection and treatment of developmental delays can improve outcome, little is known about factors that influence how primary care physicians manage young children with probable developmental delays. The objective of this study was to describe physician referral practices for children with developmental delays and to test whether the probability of referral is increased by 1) the expression of parental concern; 2) female gender in a child with language delay; 3) disruptive, as opposed to avoidant behaviors; and 4) physician characteristics, including female gender or being a pediatrician. METHODS: A cross-sectional survey was mailed to a national random sample of 800 pediatricians and 800 family practice physicians in primary care practice, using an experimental randomized block design. Recipients randomly received alternative variants of clinical vignettes, which differed only in regard to the variable specific to each of the first 3 hypotheses. Physicians answered questions about the likelihood of referral on a 5-point scale for listed referral options. Hypotheses were tested using multivariable logistic regression modeling. A total of 55% of pediatricians and 43% of family practice physicians returned the survey, for an overall response rate of 49%. RESULTS: A girl with language delay was 60% more likely to be referred to audiology than a boy (odds ratio: 1.6; 95% confidence interval: 1.1-2.3), and respondents who were female or pediatricians were more likely to refer patients. The expression of parental concern did not increase the probability of referral to diagnostic and treatment services, and avoidant rather than disruptive patient behaviors were associated with an increased probability of referral. CONCLUSIONS: Patient gender and type of behavioral presentation seem to influence referrals to diagnostic and treatment services for young children with probable developmental delays described in clinical vignettes. These findings can guide targeted educational interventions to increase rates of detection and referral for young children with developmental delays.

Child, Preschool↗
PubMed2003

Training graduate-level pediatric psychology researchers at Case Western Reserve University: meeting the challenges of the new millennium.

OBJECTIVE: To describe the challenges in training graduate-level pediatric psychology researchers for successful careers and to discuss solutions. METHODS: We reviewed experiences in training graduate students at Case Western Reserve University to identify key challenges in research training and potential strategies to meet them. RESULTS: We identified the following key challenges: stimulating graduate students' career interest in pediatric psychology research; teaching students about the pragmatic challenges of conducting research in pediatric settings, specialized research design, and data analytic issues; helping students to develop essential research skills; developing opportunities for student research-related collaborations; helping students develop professional identities as researchers; and developing and supporting their research careers beyond graduate school. CONCLUSIONS: Useful strategies for meeting these challenges include involving an interdisciplinary faculty in research training; developing specialized training methods that focus on critical research skills such as writing and data analysis; peer support; and involvement with multiple mentors who are successful researchers. Pediatric psychologists should also develop opportunities for the next generation of researchers by facilitating research job options and leadership opportunities.

Child↗
PubMed2003

Long-term behavior problems following pediatric traumatic brain injury: prevalence, predictors, and correlates.

OBJECTIVE: To study identified rates of long-term behavior problems in children with traumatic brain injury (TBI) compared to children with only orthopedic injuries and risk factors and correlates for new behavior problems following TBI. METHODS: Sample included children with severe TBI (n = 42), moderate TBI (n = 41), and orthopedic injuries only (ORTHO;n = 50). The baseline assessment measured child behavior, adaptation, and neuropsychological, academic, and family functioning. Follow-ups were conducted at 6 and 12 months and at an extended follow-up a mean of 4 years after injury. RESULTS: The prevalence of caseness, defined as elevated behavior problem ratings, was higher in one or both TBI groups than in the ORTHO group at each follow-up (e.g., 36% of severe TBI group, 22% of moderate TBI group, and 10% of ORTHO group at extended follow-up). Most instances of postinjury-onset caseness at the extended follow-up were evident within the first year after TBI. Predictors were severe TBI, socioeconomic disadvantage, and preinjury behavioral concerns. Concurrent correlates included weakness in working memory and adaptive behavior skills, poorer behavior and school competence, and adverse family outcomes. CONCLUSIONS: Postinjury-onset caseness is persistent, risks are multifactorial, and correlates include child dysfunction and family sequelae.

Brain Injuries↗
PubMed2003

Discrepancies between mother and adolescent perceptions of diabetes-related decision-making autonomy and their relationship to diabetes-related conflict and adherence to treatment.

OBJECTIVE: To document the relationship between discrepancies in mother and adolescent perceptions of diabetes-related decision-making autonomy, diabetes-related conflict, and regimen adherence. METHODS: The sample was composed of 82 mother-adolescent dyads. Measures included adolescent and mother reports of diabetes-related decision-making autonomy, diabetes-related conflict, and regimen adherence. Nurses' reports of adherence and number of glucose tests performed each day were also obtained. RESULTS: Discrepancies between mother and adolescent perceptions of decision-making autonomy were related to greater maternal report of diabetes-related conflict. In particular, when adolescents reported that they were more in charge of decisions than reported by their mothers, mothers reported more conflict. Discrepancies between mother and adolescent perceptions of decision-making autonomy were not related to regimen adherence. CONCLUSIONS: The findings suggest that discrepancies between mother and adolescent perceptions of diabetes-related decision-making autonomy may be a potentially important area for intervention.

Adolescent↗
PubMed2003

Predicting attrition in a pediatric asthma intervention study.

OBJECTIVES: To operationalize a comprehensive description of attrition, including pre-inclusion, dropout, and attrition due to intermittent missing data, and to test a predictive model of attrition using a data set from a randomized controlled intervention in pediatric asthma. METHODS: Participants included children, ages 4-12, diagnosed with asthma and their caregivers. Demographic variables and outcome measures of asthma morbidity were examined in 327 families to determine their association with attrition. RESULTS: Families who did not complete randomization and the intervention tended to have younger caregivers than did completers. Caregiver age emerged as the most consistent predictor of pre-inclusion and dropout attrition. There were no significant predictors of attrition due to intermittent missing data. CONCLUSION: Younger caregivers may be at particular risk for attrition in pediatric asthma intervention studies and warrant special attention by investigators.

Asthma↗
PubMed2003

Sibling relationships and behavior after pediatric traumatic brain injury.

To evaluate long-term outcomes for siblings of children with traumatic brain injury (TBI), measures of sibling relationships and sibling behavior were collected an average of 4 years postinjury. The study sample included participants in a larger longitudinal study who had school-aged siblings, including 34 with severe TBI, 30 with moderate TBI, and 39 with orthopedic injuries not involving brain insult (ORTHO group). Group comparisons revealed more negative sibling relationships in families of children with TBI than in families of children in the ORTHO group, but only for mixed-gender sibling pairings. Behavior problems in children with TBI predicted both sibling relationships and sibling behavior problems. The findings indicate a need to monitor the adjustment of siblings and sibling relationships after TBI and to include siblings in family interventions.

Adaptation, Psychological↗
PubMed2003

Research on the quality of parent-provider communication in pediatric care: implications and recommendations.

This narrative review of the correlates of effective parent-provider communication and relevant interventions indicates that effective parent-provider communication is associated with parental satisfaction with care, adherence to treatment recommendations, and enhanced discussion of psychosocial concerns. Moreover, interventions designed to improve parent-provider communication resulted in more discussion of psychosocial concerns, better recall of information from the visit, and improved parent-provider communication. Recommendations for the development of more effective studies of parent-provider communication and relevant interventions in pediatric primary care include the need for theoretical models to help guide research, the development of reliable and valid self-report measures of communication, the assessment of clinically relevant correlates of parent-provider communication, and the study of children's roles in communication with their pediatricians.

Communication↗
PubMed2003

How do primary care physicians identify young children with developmental delays? A national survey.

Little is known about the current practices of primary care physicians regarding developmental surveillance and screening during pediatric preventive care visits. We conducted a mailed survey of a random national sample of pediatricians and family physicians to describe their practices and identify factors that predict use of developmental screening tools, an efficacious way of identifying children with developmental delays. Most physicians reviewed developmental milestones and prompted parents for developmental concerns at preventive care visits. Approximately half of the physicians used a formal developmental screening instrument. Female physician gender predicted higher rates of use of screening tools for family physicians, but not for pediatricians. Most physicians seemed committed to the early diagnosis of developmental delays. Substantial variability in surveillance and screening practices, barriers of time and reimbursement, and under-reliance on parent-completed questionnaires underscore areas for improvement.

Adult↗
PubMed2003

Barriers to mental health referral from pediatric primary care settings.

OBJECTIVE: To examine the frequency of barriers to mental health referral according to pediatric primary care physician (PCP) report and to identify factors related to perceptions of referral barriers for patients with managed care coverage. DESIGN AND METHODS: Data from a national sample of 319 PCPs were examined. Comparisons were made concerning the frequency of PCP-reported barriers to mental health referrals for patients with fee-for-service versus managed care coverage. The relationship between relevant factors (eg, practice structure, interdisciplinary office staff, availability of community mental health resources) and perceived barriers was examined for managed care coverage. RESULTS: Barriers to mental heath referrals were more commonly reported for those with managed care versus fee-for-service coverage for 11 of the 12 barriers assessed (P < .0001). For patients with managed care coverage a high availability of community mental health resources was associated with fewer perceived barriers among physicians (P < .0001). CONCLUSIONS: Our findings suggest that PCPs perceive barriers to mental health referrals as common challenges when addressing psychosocial concerns. Referral barriers were more commonly reported for patients with managed care coverage. Increasing the availability of community mental health resources was identified as an important variable in facilitating appropriate referrals.

Child↗