Browsing by Subject "Children"
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Item Acute Treatment Outcomes and Family Functioning of Children and Adolescents Diagnosed with Anorexia Nervosa(2006-08-11) Hetrick, Maryann O.; Kennard, Beth D.Recent studies have suggested that there is a relationship between treatment outcomes and baseline factors related to family functioning and specific eating disorder symptoms. However, these relationships have not been studied extensively within a pediatric population hospitalized for treatment. Therefore, it is unknown whether these relationships exist within an acutely ill population and whether these baseline characteristics improve significantly immediately following acute hospitalization. Given these limitations, the aims of the present study were to identify aspects of family functioning and eating cognitions and attitudes at admission that predict outcome at discharge, and evaluate what aspects of family functioning and eating cognitions and attitudes improve during an acute treatment period. The sample consisted of 41 patients diagnosed with anorexia nervosa or eating disorder not otherwise specified between the ages of 10 and 17 years. At admission, all patients were administered a structured clinical interview to obtain valid psychiatric diagnoses. Additionally, patients completed self-report measures of eating cognitions, eating attitudes, and family functioning; while parents completed a self-report measure of family functioning. Families also participated in a standardized clinician-rated observational measure of family functioning. All measures were re-administered at discharge, and the patient's body mass index (BMI) at admission and discharge were obtained from the medical record. The attrition rate from intake to discharge for this study was 26.8%. Overall, it appeared that parents and patients perceived their families to be healthy at intake, with little improvements noted over the course of treatment. However, standardized observations characterized these families as being affectively avoidant. Additionally, parental perception of adaptive family functioning at intake was predictive of outcome based upon the unit psychiatrist's assessment, and patient perception of healthy familial Expressiveness at intake was predictive of outcome based upon pathological eating attitudes. BMI and eating attitudes based upon eating behavior during treatment improved significantly over the course of treatment. However, patients continued to endorse unhealthy eating cognitions at discharge. These results suggest that weight restoration and pathological eating behavior are the first symptoms to improve during an aggressive treatment period, and psychological symptoms may require a longer period of treatment to remit.Item The Changing Epidemiology of Musculoskeletal Infection in Children: Impact on Evaluation and Treatment at a Tertiary Pediatric Medical Center in the Southwest United States(2007-12-03) Hollmig, S. Tyler; Copley, Lawson A. B.BACKGROUND: Recent reports illustrate an increased incidence and severity of deep musculoskeletal infections in children. Our purpose was to review the historical experience with deep musculoskeletal infection at a tertiary pediatric medical center in the southwest United States and to compare this past experience with the more recent experience within the same institution. METHODS: A retrospective review was performed of children treated for deep musculoskeletal infection at Children's Medical Center of Dallas between January 1, 2002 and December 31, 2004. The review identified children with primary diagnoses of osteomyelitis, septic arthritis, non-tropical pyomyositis, or abscesses requiring surgical intervention. Trends were identified in terms of causative organism, anatomic location of infection, frequency of requirement of surgical debridement, and identification of adverse sequelae. These trends were compared to past experience within the same institution. RESULTS: 554 children were treated for deep musculoskeletal infection. Primary diagnoses were as follows: osteomyelitis - 212; septic arthritis - 118; pyomyositis - 20; and abscess - 204. The incidence of osteomyelitis rose from 11.7 cases per year, reported in 1982, to 70.7 cases per year, representing a six-fold increase. The incidence of septic arthritis rose from the 1982 report of 18.1 cases per year to 39 cases per year, a 2.2-fold increase. Staphylococcus aureus was responsible for the majority of infections, with methicillin resistant S. aureus representing an important cause of infection not identified in the previous study at this institution. The most common anatomic locations of infection occurred around the knee and hip joints. Deep venous thrombosis was identified as the most common major complication associated with musculoskeletal infection, with 13 cases occurring over the course of the review. DISCUSSION: We have demonstrated a change in the epidemiology among children with musculoskeletal infection at our tertiary pediatric medical center. The marked differences that are present in our current practice when compared to the experience at the same institution over twenty years ago have prompted a detailed look into this epidemiology. The emergence of methicillin resistant S. aureus, the association of deep venous thrombosis musculoskeletal infection, and the reported occurrence of non-tropical pyomyositis, were unique finding in our study. Our recent experience demonstrated trends that motivated the development of clinical practice guidelines for the evaluation and treatment of pediatric musculoskeletal infection. Future prospective work will be necessary to study the success of implementation of these evidence based guidelines as well as to ascertain their merit in terms of beneficial clinical outcomes.Item Discrimination Between Frontal and Temporal Lobe Epilepsy in Children(2006-05-15) Clark, Jennifer Paulette Holinbaugh; Silver, Cheryl H.Distinguishing between children with frontal lobe epilepsy (FLE) and children with temporal lobe epilepsy (TLE) can be difficult; however, in order to assure proper treatment and intervention it is important to accurately differentiate between these two groups. One of the intended goals of this study is to identify tabletop and behavioral rating measures that will assist in differentiating children with FLE from children with TLE. Another purpose of this study is to examine the utility of the Children's Executive Functions Scale (CEFS), a parent-report measure of executive functioning, in differentiating between children with FLE and TLE. Sixty children, ranging in age from 6 to 17, will be divided into two groups (a) children with frontal lobe epilepsy and (b) children with temporal lobe epilepsy. The participants will be evaluated using the Tower of London (TOL), The Wide Range Assessment of Memory and Learning - 2 (WRAML-2), the CEFS, and the Child Behavior Checklist (CBCL). It is hypothesized that children with FLE will display more impairment than children with TLE on both measures of executive functioning (the CEFS and the TOL). It is further hypothesized that children with RTLE will perform significantly worse visual memory components of the WRAML-2 than individuals with FLE or LTLE . It is expected that children with LTLE will perform worse than children with RTLE or FLE on verbal memory components of the WRAML-2. Finally, it is hypothesized that scores on the CBCL will reflect that children with TLE display a greater number of internalizing symptoms than children with FLE. The findings of this study could also have important implications in the understanding of deficits associated with FLE and TLE. Furthermore, the findings could suggest direction for future research and for treatment and interventions.Item Medication Adherence in Children and Adolescents with Major Depressive Disorder(2006-08-11) Sternweis, Kathryn VanArsdale; Hughes, Carroll W.Major Depressive Disorder (MDD) is a serious psychiatric disorder in children and adolescents where antidepressant adherence remains an important issue. The present study uses electronic monitoring (Medication Event Monitoring System, APREX, Fremont, California [MEMS® caps]) to compare various methods of measuring adherence. Subjects who met the Diagnostic and Statistical Manual of Mental Disorders' (DSM-IV) criteria for MDD participated in a randomized controlled trial involving fluoxetine. A subset of patients had their medication adherence monitored for up to 12 weeks using MEMS caps, blood levels, self-report, medication diaries, physicians' estimates, and pill counts. Throughout the 12-week process, patients also completed a number of questionnaires assessing treatment expectancy, side effects, family functioning, school functioning, cognitive beliefs, depressive symptoms, and the identity of the individual(s) dispensing medication.Item [News Item](1952-12-15) Aagaard, George N.Item Relationship of Internalizing Behavior Problems to Intelligence and Executive Functioning in Children(2005-12-20) McClintock, Shawn Michael; Silver, Cheryl H.The current theme of research regarding children has focused greatly on emotional intelligence, Attention Deficit Hyperactivity Disorder (ADHD), and other problems involving emotional disorders. While there is a great amount of research devoted to these topics, there is a lack of consensus on the effects these emotional disorders have on the areas of intelligence and executive functioning in children. This study examined the relationship between internalizing behavior problems (depression, anxiety, and social withdrawal) and intelligence and executive functioning in children. Archival data, from 75 children between the ages of 6 and 14, were used. The sample consisted of children with internalizing behavior problems and children without internalizing or externalizing behavior problems, which was classified using the Child Behavior Checklist (CBCL). Each child was evaluated using the Wechsler Intelligence scale for Children-Third Edition (WISC-III), Children's Executive Function Scale (CEFS), and the Category Test. Results indicated that children with internalizing behavior problems performed significantly worse in domains of global executive function, problem solving, and initiative. No significant differences were found between the control and internalizing groups in the domain of intellectual functioning. This study supports the premise that executive function and intelligence are separate domains and should both be assessed in children with internalizing behavior disorders.Item Residual Symptoms in Pediatric Depression after Acute Pharmacological Treatment(2006-08-11) Sowell, Morgan Michelle; Kennard, Beth D.Children and adolescents with major depressive disorder (MDD) are at an increased risk for school failure, school drop out, and suicidality. Childhood onset of MDD has been linked to an increased likelihood of relapse of MDD in child and adolescent research. Adult studies have found that residual symptoms increase the risk of relapse, and shorten the time to onset of relapse. This study sought to confirm the presence of residual symptoms in children and adolescents after successful treatment with antidepressant medication. An additional objective was to identify predictors of remission in those who have an adequate response to treatment. The participants (N=315) are from a combined data set of two separate studies conducted by Graham J. Emslie investigating the efficacy of fluoxetine 20 mg/day for 8 weeks in children and adolescents with non-psychotic depression. Evaluating the patients using the more stringent criteria of remission in responders, showed that 64% of fluoxetine treated patients, and 56% of placebo treated patients successfully achieved remission. In this subgroup of responders, dysthymic disorder and CDRS-R total baseline score were found to be predictive of responders who remit. Residual symptoms were found to be present in both the fluoxetine and placebo treatment group responders in high frequency. Finally, using the CDRS-R individual item scores of ≥3, fourteen different types of residual symptoms where found for the 86 fluoxetine responders, and eleven different types of residual symptoms were found for the 57 placebo responders.Item [Southwestern News](2001-05-03) Echeverria, IoneItem [Southwestern News](2002-09-30) Harrell, AnnItem [Southwestern News](2004-02-24) Siem, Staishy BostickItem [Southwestern News](2002-08-27) Bedrick, BarbaraItem [Southwestern News](2003-04-23) Siem, Staishy BostickItem [Southwestern News](2003-08-25) Siem, Staishy BostickItem [Southwestern News](2004-09-09) Siem, Staishy BostickItem [Southwestern News](2000-12-05) Shields, AmyItem [Southwestern News](2002-10-31) Morrison, SusanItem [Southwestern News](2001-04-23) Echeverria, Ione; Cofer, BrianItem [Southwestern News](2004-03-25) Siem, Staishy BostickItem [Southwestern News](2000-12-04) Cofer, BrianItem [Southwestern News](2004-08-12) Siem, Staishy Bostick
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