Medicine and Health Sciences Commons^™

Psychosocial Determinants Of Physical Activity In Children Attending Afterschool Programs : A Path Analysis., Jiying Ling, Lorraine B. Robbins, Valerie L. Mccarthy, Barbara J. Speck

Valerie L. McCarthy

Background: Physical activity (PA) is important for controlling childhood obesity, but a comprehensive PA model for school-aged children is lacking. Objectives: Guided by the youth PA promotion (YPAP) model, this study estimated the direct and indirect effects of self-efficacy, enjoyment, parental influence, and environment on self-reported PA and pedometer steps. A secondary purpose was to explore the association between self-reported PA and pedometer steps. Methods: An observational and prospective study was conducted among 133 children, aged 8–11 years old, from 10 elementary schools with afterschool programs in a Midwestern U.S. school district from August through October 2013. PA was assessed …

Social Support To Empower Parents (Step): An Intervention For Parents Of Young Children Newly Diagnosed With Type 1 Diabetes, Susan Sullivan-Bolyai, Carol Bova, Katherine Leung, Allison Trudeau, Mary Lee, Philip Gruppuso

Mary M. Lee

PURPOSE: The purpose of this study was to test the efficacy of a social support intervention with parents of children <13 years old newly diagnosed with type 1 diabetes mellitus>(T1DM).

METHODS: For this randomized, controlled clinical trial, 10 parent mentors of children diagnosed with T1DM >or=1 year and 60 parent participants were recruited from 2 pediatric diabetes centers. Mentors were trained to provide social support (home visits and phone calls) for 12 months to families in the experimental arm (32 mothers). Control group parents (28 mothers) received the phone number of an experienced parent (not trained to give social support) to call as needed.

FINDINGS: Mothers in the experimental …

Depression Screening Of Perinatal Women By The Des Moines Healthy Start Project: Program Description And Evaluation, Lisa Segre, M. O'Hara, R. Brock, D. Taylor

Lisa S. Segre

OBJECTIVE: Maternal depression is linked to poor infant and child outcome. In 2001, the U.S. Health Resources and Services Administration required all Healthy Start programs to incorporate maternal-depression screening as part of home visiting services. This article describes the implementation and results of depression screening by the Des Moines Healthy Start Project between 2002 and 2009. The study represents the first longitudinal assessment of the Healthy Start maternal-depression screening initiative. METHODS: The evaluation assessed staff compliance with a protocol for screening for depression among clients at regular intervals during the prenatal and postnatal periods until the client's child was two …

Design, Implementation, And Evaluation Of A Bronchiolitis Clinical Pathway, Suzanne E. Zentz

Suzanne E Zentz, DNP, RN, CNE

Bronchiolitis is the most frequent cause of hospitalization in the infant population. The management of these hospitalized children varies widely and the efficacy of many routinely implemented diagnostics and therapies is not supported by evidence (Christakis et al., 2005). The purpose of this evidence-based practice project was to determine if designing, implementing, and evaluating a clinical pathway for infants and children with bronchiolitis would affect length of stay and bronchodilator,glucocorticoid, antibiotic, and CPT usage. The Iowa model of evidence-based practice to promote quality care was used as a framework to guide the project at a 227 bed non-profit facility in …

Achievement Test Performance In Children Conceived By Ivf, L. Mains, M. Zimmerman, J. Blaine, B. Stegmann, Amy Sparks, T. Ansley, Bradley Van Voorhis

Amy E.T. Sparks

BACKGROUND: Long-term follow-up studies of children conceived by IVF are limited. We examine academic performance on standardized tests [Iowa Tests of Basic Skills/Educational Development (ITBS/ITED)] of children conceived by IVF. METHODS: Parents of children 8-17 years of age at the onset of the study (March 2008) who were conceived by IVF at the University of Iowa Hospitals and Clinics and living in the state of Iowa were contacted by mail. Parents completed questionnaires on their child's health and education and parental education. ITBS/ITED scores from school grades 3-12 were obtained on IVF children and a group of anonymous children matched …

Achievement Test Performance In Children Conceived By Ivf, L. Mains, M. Zimmerman, J. Blaine, B. Stegmann, Amy Sparks, T. Ansley, Bradley Van Voorhis

Bradley J Van Voorhis

BACKGROUND: Long-term follow-up studies of children conceived by IVF are limited. We examine academic performance on standardized tests [Iowa Tests of Basic Skills/Educational Development (ITBS/ITED)] of children conceived by IVF. METHODS: Parents of children 8-17 years of age at the onset of the study (March 2008) who were conceived by IVF at the University of Iowa Hospitals and Clinics and living in the state of Iowa were contacted by mail. Parents completed questionnaires on their child's health and education and parental education. ITBS/ITED scores from school grades 3-12 were obtained on IVF children and a group of anonymous children matched …

Ultrasound-Assisted Repair Of A Unique Case Of Distal Vaginal Agenesis, J. Kresowik, Ginny Ryan, J. Austin, Bradley Van Voorhis

Bradley J Van Voorhis

OBJECTIVE: To describe a unique vaginal outlet obstruction and its ultrasound-assisted surgical correction. DESIGN: Case report. SETTING: An academic medical center. PATIENT(S): A 12-year-old girl was seen with cyclic abdominal pain, nausea, and an abdominal mass. External genital examination revealed no vaginal opening or dimple. Transabdominal ultrasound revealed a large hematometrocolpos 5 cm proximal to the perineum, with an otherwise normal-appearing uterus and ovaries. INTERVENTION(S): Surgical treatment included perineal incision, creation of a 5-cm passage through connective tissue, drainage of the hematometrocolpos, and mobilization of the proximal vagina, allowing for pull-through vaginoplasty. Ultrasound guidance was used throughout the surgery and …

Ultrasound-Assisted Repair Of A Unique Case Of Distal Vaginal Agenesis, J. Kresowik, Ginny Ryan, J. Austin, Bradley Van Voorhis

Ginny L. Ryan

OBJECTIVE: To describe a unique vaginal outlet obstruction and its ultrasound-assisted surgical correction. DESIGN: Case report. SETTING: An academic medical center. PATIENT(S): A 12-year-old girl was seen with cyclic abdominal pain, nausea, and an abdominal mass. External genital examination revealed no vaginal opening or dimple. Transabdominal ultrasound revealed a large hematometrocolpos 5 cm proximal to the perineum, with an otherwise normal-appearing uterus and ovaries. INTERVENTION(S): Surgical treatment included perineal incision, creation of a 5-cm passage through connective tissue, drainage of the hematometrocolpos, and mobilization of the proximal vagina, allowing for pull-through vaginoplasty. Ultrasound guidance was used throughout the surgery and …

Intrinsic Differences In The Response Of The Human Lutropin Receptor Versus The Human Follitropin Receptor To Activating Mutations, Meilin Zhang, Ya-Xiong Tao, Ginny Ryan, Xiuyan Feng, Francesca Fanelli, Deborah Segaloff

Ginny L. Ryan

In contrast to the human lutropin receptor (hLHR), very few naturally occurring activating mutations of the structurally related human follitropin receptor (hFSHR) have been identified. The present study was undertaken to determine if one aspect underlying this discrepancy might be a general resistance of the hFSHR to mutation-induced constitutive activity. Five different mutations were introduced into both the hLHR and hFSHR (four based on activating mutations of the hLHR gene, one based on an activating mutation of the hFSHR gene). Our results demonstrate that hFSHR constitutively activating mutants (CAMs) were not as active as hLHR CAMs containing the comparable mutation. …

Evaluating The Roles Of Follicle-Stimulating Hormone Receptor Polymorphisms In Gonadal Hyperstimulation Associated With Severe Juvenile Primary Hypothyroidism, Ginny Ryan, X. Feng, C. D'Alva, M. Zhang, Bradley Van Voorhis, E. Pinto, A. Kubias, S. Antonini, A. Latronico, D. Segaloff

Ginny L. Ryan

CONTEXT: Rare activating mutations of the human (h)FSHR have been reported in some women with spontaneous ovarian hyperstimulation in pregnancy, where follicular growth is inappropriately stimulated by elevated concentrations of human chorionic gonadotropin acting through the hFSHR. It is not known whether ovarian hyperstimulation in peripubertal girls with untreated primary hypothyroidism is caused by hFSHR mutations and/or influenced by hFSHR allelic variants, rendering the hFSHR more sensitive to circulating TSH. OBJECTIVE: The aim of the study was to determine whether mutations of the hFSHR and/or hFSHR allelic variants are associated with greater sensitivity of the hFSHR to TSH. DESIGN: The …

Molecular Analysis Of The Neuropeptide Y1 Receptor Gene In Human Idiopathic Gonadotropin-Dependent Precocious Puberty And Isolated Hypogonadotropic Hypogonadism, K. C. Freitas, Ginny Ryan, V. N. Brito, Y. X. Tao, E. M. Costa, B. B. Mendonca, D. Segaloff, A. C. Latronico

Ginny L. Ryan

OBJECTIVE: To investigate the role of mutations or polymorphisms in the NPY-Y1R gene in human idiopathic central pubertal disorders. DESIGN: Molecular studies. SETTING: University hospital. PATIENT(S): Thirty-three patients with gonadotropin-dependent precocious puberty, 22 with hypogonadotropic hypogonadism, and 50 controls. INTERVENTION(S): Genomic DNA extraction, NPY-Y1R gene sequence analysis, cell-surface expression, and functional activity of an identified receptor variant. MAIN OUTCOME MEASURE(S): Results of sequencing, cell-surface receptor expression, and receptor function. RESULT(S): A heterozygous substitution of lysine (K) by threonine (T) at position 374 in the carboxyl terminal region of NPY-Y1R was identified in a girl with familial GDPP. Her mother, who …

Cornual Contraction Ring With Retained Placenta In Midtrimester Abortion, Jennifer Niebyl, A. Montague, A. Tapper, T. Horrigan

Jennifer R Niebyl

No abstract provided.

Heparin Vs. Saline For Peripheral I.V. Locks In Children, Charmaine Kleiber, Kirsten Hanrahan, C. Fagan, M. Zittergruen

Kirsten M. Hanrahan

PURPOSE: To determine the efficacy of saline versus heparin flush solution to maintain peripheral i.v. locks in a pediatric population. METHOD: A prospective, randomized, double-blind design was used. A sample of 124 peripheral i.vs. were flushed with either saline or heparin in saline. Subjects were infants over 28 days of age and children. FINDINGS: The heparin and saline groups were comparable for total hours duration of the i.v. and for incidence of complications. CONCLUSIONS: Saline is efficacious in maintaining patency of peripheral i.v. locks in children over 28 days of age.

Development Of The Distraction Coaching Index, Charmaine Kleiber, Ann Mccarthy, Kirsten Hanrahan, L. Myers, N. Weathers

Kirsten M. Hanrahan

Children's distress during medical procedures can be decreased when professionals or parents provide distraction coaching, but the quality of distraction may contribute to the variation in the results. This article describes the development of the Distraction Coaching Index (DCI), a tool for measuring the quality and frequency of distraction coaching. Nominal group technique and consensus agreement were used for concept clarification and development of behavioral indicators and descriptors. Videotapes of untrained parents, trained parents, and expert professional coaches, who provided distraction to children (4-10 years old) undergoing peripheral intravenous catheter insertion, were used to assess interrater reliability and construct validity. …

Strategies For Salivary Cortisol Collection And Analysis In Research With Children, Kirsten Hanrahan, Ann Mccarthy, Charmaine Kleiber, S. Lutgendorf, E. Tsalikian

Kirsten M. Hanrahan

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) …

Normative Salivary Cortisol Values And Responsivity In Children, Ann Mccarthy, Kirsten Hanrahan, Charmaine Kleiber, M. Zimmerman, S. Lutgendorf, E. Tsalikian

Kirsten M. Hanrahan

This was a descriptive study on normative salivary cortisol values and responsivity to a hospital clinic visit and an intravenous (IV) procedure in children. The study presented was a subproject of a primary research study that examined parents coaching their children requiring an IV placement in the use of distraction. One measure of child response in the primary study, salivary cortisol, was included to further our understanding of children's physiologic response to stressful and painful stimuli. Salivary cortisol samples were obtained from 384 children aged between 4 and 10 years upon arrival to the clinic and 20 minutes after their …

Integrating Molecular Genetics Analyses Into Clinical Research, D. Schutte, Ann Mccarthy, M. Floria-Santos, Kirsten Hanrahan, J. Murray, Charmaine Kleiber

Kirsten M. Hanrahan

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 …

Factors Explaining Children's Responses To Intravenous Needle Insertions, Ann Mccarthy, Charmaine Kleiber, Kirsten Hanrahan, M. Zimmerman, N. Westhus, S. Allen

Kirsten M. Hanrahan

BACKGROUND: Previous research shows that numerous child, parent, and procedural variables affect children's distress responses to procedures. Cognitive-behavioral interventions such as distraction are effective in reducing pain and distress for many children undergoing these procedures. OBJECTIVES: The purpose of this report was to examine child, parent, and procedural variables that explain child distress during a scheduled intravenous insertion when parents are distraction coaches for their children. METHODS: A total of 542 children, between 4 and 10 years of age, and their parents participated. Child age, gender, diagnosis, and ethnicity were measured by questions developed for this study. Standardized instruments were …

Predictors Of Topical Anesthetic Effectiveness In Children, Charmaine Kleiber, D. Schutte, Ann Mccarthy, M. Floria-Santos, J. Murray, Kirsten Hanrahan

Kirsten M. Hanrahan

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 …

Impact Of Parent-Provided Distraction On Child Responses To An Iv Insertion, Ann Mccarthy, Charmaine Kleiber, Kirsten Hanrahan, M. Zimmerman, N. Westhus, S. Allen

Kirsten M. Hanrahan

This study evaluates the impact of parent-provided distraction on children's responses (behavioral, physiological, parent, and self-report) during an IV insertion. Participants were 542 children, 4 to 10 years old, randomized to an experimental group that received a parent distraction coaching intervention or to routine care. Experimental group children had significantly less cortisol responsivity (p = .026). Children that received the highest level of distraction coaching had the lowest distress on behavioral, parent report, and cortisol measures. When parents provide a higher frequency and quality of distraction, children have lower distress responses on most measures.

Cognitive Behavioral Interventions For Children During Painful Procedures: Research Challenges And Program Development, Ann Mccarthy, V. Cool, Kirsten Hanrahan

Kirsten M. Hanrahan

The purpose of this report is to describe a pilot program designed to introduce the use of cognitive behavioral interventions for painful pediatric procedures at a university hospital, and to discuss the challenges that occurred during this process. Participants in the program included ten parents and their children who were newly diagnosed with leukemia, and staff who provided treatment for these children. Measures included direct videotaped observations of the children, perceptions of pain and anxiety completed by children, parents, and staff, and parent and staff ratings of satisfaction with the program. Results indicated strong acceptance of the interventions. This report …

Sleeplessness, Deborah Schoenfelder, Keela Herr

Deborah P. Schoenfelder

This article identifies and reviews research related to sleeplessness reported by nurses in the literature. The current state of clinical nursing research as it relates to sleep is evaluated, including the content, methodology, and implications for further research. Although the review indicates current interest in sleep by clinical nurse researchers, the number of nursing studies in the literature is limited, especially within specific areas, such as age groups and setting. Also, directions for future nursing research on sleep are recommended.

Ambulatory Surgery. The Selection And Administration Of Perioperative Intravenous Fluids For The Pediatric Patient, J. Aker, Cormac O'Sullivan

Cormac T. O'Sullivan

No abstract provided.

Evaluation Of Vehicle Substances On Vitamin D Bioavailability: A Systematic Review, Ruth Grossmann, V. Tangpricha

Ruth E. Grossmann

Vitamin D insufficiency is a common medical condition. Vitamin supplements can be ingested to improve vitamin D status. It is not known if the vehicle substance that is combined with the vitamin D tablet influences the bioavailability of vitamin D. The purpose of this review is to examine the impact of different vehicles on vitamin D bioavailability. A comprehensive literature search identified studies that directly compared the absorption of vitamin D from two or more vehicles. The change in mean serum 25(OH)D per average daily dose of vitamin D supplemented was calculated and compared among the studies. We identified four …

Accessing Asthma Care: A Case Study Of Urban Children, Andrea Wallace

Andrea S. Wallace

The purpose of this exploratory, descriptive study was to identify factors that facilitate or impede the use of health care resources by urban children with asthma. Using an embedded case study design, the study considered the issue of health care access for urban children with asthma by focusing on attributes that impede and facilitate these children's access to health care resources. Interview, demographic, survey, and medical records data were analyzed for 34 parent-child dyads accessing asthma care in one metropolitan health care system. Interview data from 14 health care professionals were also analyzed. These findings were then compared with utilization …

Special Report: Nursing. A Research-Based Sibling Visitation Program For The Neonatal Icu... Reprinted From Critical Care Nurse, Vol. 17, No. 2, April 1997, Innovision Communications, Aliso Viejo, Ca, L. Montgomery, Charmaine Kleiber, A. Nicholson, Martha Craft-Rosenberg

Martha J. Craft-Rosenberg

No abstract provided.

Professional Issues. Health Care Quality And Outcome Guidelines For Nursing Of Children And Families: Implications For Pediatric Nurse Practitioner Practice, Research, And Policy, C. Betz, J. Cowell, Martha Craft-Rosenberg, M. Krajicek, M. Lobo

Martha J. Craft-Rosenberg

No abstract provided.

Health Care Quality And Outcome Guidelines For Nursing Of Children And Families: Implications For Pediatric Nurse Practitioner Practice, Research, And Policy, C. Betz, J. Cowell, Martha Craft-Rosenberg, M. Krajicek, M. Lobo

Martha J. Craft-Rosenberg

No abstract provided.

The Disclosure Decisions Of Parents Who Conceive Children Using Donor Eggs, S. Hahn, Martha Craft-Rosenberg

Martha J. Craft-Rosenberg

STUDY OBJECTIVE: To identify variables that influence the disclosure decisions of parents who conceive children using donor eggs and to compare such variables among disclosing, nondisclosing, and undecided families. DESIGN: Exploratory, comparative, descriptive. SETTING: A university hospital-assisted reproductive technology program in the Midwest. PARTICIPANTS: Thirty-one couples with children conceived with anonymously donated eggs. METHODS: Audiotaped telephone interviews, measures of social support and family environment, and a demographic survey. MAIN OUTCOME MEASURES: Content analysis of interview transcripts and comparison of recurring themes among groups. RESULTS: The majority of parents intended disclosure. Dominant themes among disclosing parents included the belief that a …

A Research-Based Sibling Visitation Program For The Neonatal Icu, L. Montgomery, Charmaine Kleiber, A. Nicholson, Martha Craft-Rosenberg

Martha J. Craft-Rosenberg

No abstract provided.