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Biomedical subjects

Lee M Ritterband

Publications and source records attributed to Lee M Ritterband.

10 recordsLinked to original sources
PubMed2026

Sex differences in sleep and alcohol consumption outcomes following a digital insomnia intervention.

BACKGROUND: Poor sleep is a well-established risk factor for heavy drinking, and evidence suggests that sleep could serve as a potential treatment target for reducing alcohol consumption. The relationship between poor sleep and problematic drinking appears to be stronger among females, but no studies to date have assessed sex differences in alcohol consumption following insomnia treatment. Here, we combine the samples from two clinical trials to investigate sex differences in the effects of a digital cognitive behavioral therapy for insomnia (Sleep Healthy Using the Internet; SHUTi) on sleep and alcohol outcomes. METHODS: 184 heavy drinking individuals with insomnia (weekly binge episodes: 4/5 + drinks in one sitting for females/males; AUDIT score >7; ISI score >14) were randomly assigned to either the SHUTi program (n = 102) or an active control program (n = 82). Participants completed self-report assessments at baseline, immediately following the 9-week intervention period, and at 3 and 6-months post-intervention. RESULTS: Linear mixed effects models showed that SHUTi effects over time were stronger among females than males for improved sleep outcomes and reduced frequency of total and heavy drinking days (ps ≤ 0.038). Follow-up comparisons of within-group effect sizes revealed consistently larger reductions in alcohol consumption among SHUTi females (Cohen's d range = 0.92-2.23) than SHUTi males (Cohen's d range = 0.65-1.95). CONCLUSIONS: Findings suggest that SHUTi may be more efficacious in improving sleep and reducing drinking among females with insomnia compared to males. These results could have important implications for sex-specific prevention and treatment efforts for heavy drinking individuals with insomnia.

Humans↗
PubMed2006

Directions for the International Society for Research on Internet Interventions (ISRII).

In 2004, the International Society for Research on Internet Interventions (ISRII) was formed to encourage eHealth researchers to collaborate in their efforts to further the science behind developing, testing, and disseminating Web-based treatment programs. The group held its second meeting (April 2006) to clarify the Society's direction and identify key issues that need addressing in the field. These issues are identified and examined in the current paper. Given the success of using the Internet to treat a range of medical and mental health problems, and the growing need for better dissemination of health care, Internet interventions will almost certainly play a prominent role in global health. ISRII plans to provide the necessary venue to ensure the science driving this field is strong, enabling researchers to conduct the highest quality research and permitting meaningful conclusions from completed studies.

Behavior Therapy↗
PubMed2006

Predictors of fear of hypoglycemia in adolescents with type 1 diabetes and their parents.

OBJECTIVES: This study tested the hypothesis that both trait anxiety and hypoglycemic history contribute to fear of hypoglycemia (FOH) both in adolescents with type 1 diabetes mellitus (T1DM) and in their parents, and relationships between FOH and other variables including metabolic control, symptom perception, and use of insulin pump therapy. STUDY DESIGN: Thirty-nine parent-adolescent pairs completed questionnaires assessing background and clinical information, hypoglycemic episodes, FOH, and trait anxiety. Adolescent blood was also sampled for glycosylated hemoglobin A1c (HbA1c) measurement. RESULTS: In adolescents, both trait anxiety and frequency of severe hypoglycemic episodes were significant predictors of FOH, together accounting for almost 50% of the variance. Parental FOH was not predicted by their own trait anxiety or their child's hypoglycemic history but by whether they believed that their child carried emergency glucose. FOH was not related to metabolic control, although adolescents who experienced recent severe hypoglycemia (SH) with unconsciousness had significantly higher HbA1c. Parental trait anxiety significantly correlated with child trait anxiety, but parent-child levels of FOH were unrelated. Neither trait anxiety nor FOH related to reported symptoms, and FOH was not lower in parents with insulin pump therapy. CONCLUSIONS: Consistent with findings from adult patient populations, trait anxiety levels and recent experiences with hypoglycemia predict FOH in adolescents with T1DM. In parents, however, beliefs about their adolescents' ability to cope with hypoglycemic episodes predicted FOH. FOH in adolescents with T1DM and their parents is a complex construct influenced by multiple personality and situational and behavioral factors, and its impact on diabetes management remains unclear.

Adolescent↗
PubMed2005

Treatment of childhood constipation by primary care physicians: efficacy and predictors of outcome.

OBJECTIVE: Childhood constipation accounts for 3% of visits to general pediatric clinics and as many as 30% of visits to pediatric gastroenterologists. The majority of children who experience constipation and whose caregivers seek medical care are seen by primary care physicians such as pediatricians or family physicians. Little is known about how primary care physicians treat childhood constipation or the success of their treatments. With this study, we prospectively examined which treatments primary care physicians prescribe to children who present for the first time with constipation and how effective those treatments are. METHODS: A total of 119 children who were between 2 and 7 years of age (mean: 44.1 +/- 13.6 months) and presented to 26 different primary care physicians (15 pediatricians and 11 family physicians) for the treatment of constipation for the first time participated in this study. Parents completed daily diaries of their child's bowel habits for 2 weeks before starting treatment recommended by their primary care physician and again 2 months after treatment. The prescribed treatment was identified by reviewing office records of the treating physicians. RESULTS: After 2 months of treatment, 44 (37%) of 119 children remained constipated. In the majority (87%) of cases, physicians prescribed some form of laxative or stool softener. The most commonly prescribed laxatives were magnesium hydroxide (77%), senna syrup (23%), mineral oil (8%), and lactulose (8%). In nearly all cases, a specific fixed dose of laxative was recommended; in only 5% of cases were parents instructed clearly to adjust the dose of laxative up or down to get the desired effect. In approximately half of the cases, physicians recommended some sort of dietary intervention. Some form of behavioral intervention was mentioned in the office records of approximately one third of cases; however, in most cases, little detail was provided. In 45% of cases, physicians prescribed disimpaction using oral cathartics, enemas, or suppositories followed by daily laxatives. In 35% of cases, physicians prescribed daily laxatives without any disimpaction procedure. In the remainder, physicians prescribed only dietary changes (5%), the use of intermittent laxatives (9%), or no therapy (7%). Treatment success corresponded to how aggressively the child was treated. Specifically, children who underwent some form of colonic evacuation followed by daily laxative therapy were more likely to have responded to treatment than were those who were treated less aggressively. CONCLUSION: Primary care physicians tend to undertreat childhood constipation. After 2 months of treatment, nearly 40% of constipated children remain symptomatic.

Cathartics↗
PubMed2005

Using the internet to provide information prescriptions.

INTRODUCTION: An information prescription is the provision of specific information to a patient on how to help manage a health problem. The Internet is being used increasingly as a source for information prescriptions, with clinicians directing patients to specific Web sites. As with any health care intervention, patients' lack of compliance is a barrier to the effectiveness of Web-based information prescriptions (WebIPs). WebIPs cannot be helpful if patients do not review the information prescribed for them. OBJECTIVE: The main objective of this study was to quantify the percentage of families who visit a Web site that was specifically prescribed by their physician. In addition, the use of an e-mail reminder was used to determine if it increases the likelihood that families will visit the prescribed Web site. Finally, barriers to accessing the prescribed Web site were identified. METHODS: Children were eligible if they presented to the pediatric gastroenterology clinic with chronic constipation and/or encopresis and their family had an active e-mail account and access to the Internet in their home. During their clinic visit, physicians instructed families to visit a Web site that provided educational information pertinent to their child's problem. Families were given a form with the Web-site address and a log-in identification number. Two days after their clinic visit, half of the families received an e-mail reminding them to visit the Web site. Families were contacted 1 week after their clinic visit to identify barriers to accessing the Web site. RESULTS: Eighty-three families participated in the study. Of the 83 families, 54 (65%) visited the prescribed Web site within 1 week of their clinic visit. Families who received e-mail reminders were significantly more likely to visit the Web site than families who did not receive an e-mail reminder (77% vs 53%). This difference could not be explained by the type or speed of Internet connection or how frequently they accessed the Internet or e-mail. The most common reasons that families cited for not accessing the Web site were "I forgot" and "I didn't have time." Few families cited technical reasons for not accessing the Web site. CONCLUSIONS: Almost two thirds of the families given a WebIP logged on to the prescribed Web site. The probability that families would access the site was increased by 45% with an e-mail reminder. Clearly, e-mail prompts improve compliance to WebIPs. As content and treatment programs continue to proliferate on the Web, it is important to identify barriers and solutions to them to improve overall compliance.

Adolescent↗
PubMed2003

An Internet intervention as adjunctive therapy for pediatric encopresis.

This study evaluated the benefits of enhanced toilet training delivered through the Internet for children with encopresis. Twenty-four children with encopresis were randomly assigned to the Internet intervention group (Web) or no Internet intervention group (No-Web). All participants continued to receive routine care from their primary care physician. The Web participants demonstrated greater improvements in terms of reduced fecal soiling, increased defecation in the toilet, and increased unprompted trips to the toilet (ps<.02). Both groups demonstrated similar improvements in knowledge and toileting behaviors. Internet interventions may be an effective way of delivering sophisticated behavioral interventions to a large and dispersed population in a convenient format.

Behavior Therapy↗
PubMed2003

Assessment of behavioral mechanisms maintaining encopresis: Virginia Encopresis-Constipation Apperception Test.

OBJECTIVE: To develop and test a scale for parent and child, evaluating theoretical and clinical parameters relevant to children with encopresis. Encopretic children were hypothesized to have more bowel-specific, but not more generic, psychological problems, as compared with nonsymptomatic control children. In addition, mothers were also believed to be more discerning than children. METHODS: The Virginia Encopresis-Constipation Apperception Test (VECAT) consists of 9 pairs of bowel-specific and 9 parallel generic drawings. Respondents selected the picture in each pair that best described them/their child. It was administered to encopretic children (N = 87), nonsymptomatic siblings (N = 27), and nonsymptomatic nonsiblings (N = 35). The mothers of all the participants also completed the VECAT. Encopretic children were retested 6 and 12 months posttreatment with Enhanced Toilet Training. RESULTS: The VECAT demonstrated good test-retest reliability and internal consistency. Encopretic children and their mothers reported more bowel-specific, but not more generic, problems. Bowel-specific scores improved significantly posttreatment only for those patients who demonstrated significant symptom improvement. Mothers were significantly more discerning than children. CONCLUSION: The VECAT is a reliable, valid, discriminating, and sensitive test. Bowel-specific problems appear to best differentiate children with and without encopresis.

Child↗
PubMed2002

Diabetes and behavioral medicine: the second decade.

Diabetes management depends almost entirely on behavioral self-regulation. Behavioral scientists have continued a collaboration with other health systems researchers to develop a holistic approach to this disease. The authors summarized the literature in 4 major areas: self-management of diabetes, psychosocial adjustment and quality of life, neuropsychological impact, and psychobehavioral intervention development. Progress made in each of these areas over the past decade is highlighted, as are important issues that have not yet received sufficient scientific attention. Emerging areas likely to become central in behavioral research, such as diabetes prevention, are introduced. The future of behavioral medicine in diabetes is also discussed, including topics such as the changing role of psychologists in diabetes care, the urgent need for more and better intervention research, the growing importance of incorporating a health system-public health perspective, and obstacles to the integration of psychobehavioral approaches into routine health care delivery.

Behavioral Medicine↗
PubMedDate not supplied

Precipitants of constipation during early childhood.

BACKGROUND: Childhood constipation is a common problem, accounting for 3% of visits to pediatric clinics and 30% of visits to pediatric gastroenterologists. Estimates of the prevalence of childhood constipation vary from 0.3% to 28% with younger children being affected most often. We were unable to find any studies that specifically examine the causes of constipation in young children. Our objective of the study was to determine precipitants to constipation during early childhood. METHODS: Findings from 125 families visiting their primary care physician for the first time with a child aged between 2 and 7 years with the complaint of constipation were compared with findings from 95 children between 2 and 7 years without any history of constipation. Parents answered questions concerning family history, toilet training, and bowel habits. Parents of constipated children were asked to describe events that occurred during the 3 months before the onset of constipation and whether these events contributed to the child's constipation. RESULTS: The age and sex of children who did and did not suffer from constipation were comparable (P > .3). When compared with control children, constipated children were no more likely to have a parent (30% vs 40%, P = .14) or sibling (17% vs 14%, P = .54) with a history of constipation. Constipated children did not begin toilet training earlier than did control children (28 +/- 7 vs 27 +/- 6 months, P = .30). When compared with parents of control children, parents of constipated children reported more difficulties with toilet training (P < .001). Parents of constipated children indicated their children had more difficult and more painful defecation experiences than did parents of control children (P < .001), and constipated children were more likely to express worry about future painful defecation than were control children (P < .001). Parents of constipated children described a number of events that occurred before the onset of constipation; however, they did not consider many of the events important contributors to the constipation. Painful defecation was the event most often reported as causing the constipation. CONCLUSION: Painful defecation is the primary precipitant of constipation during early childhood. Parents should be counseled to be attentive to such experiences and taught to intervene quickly to lessen the risk that their child will develop persistent constipation or fecal soiling.

Child↗