Report (Ed. D.)--Teachers College. / Issued also on microfilm. Includes bibliographical references.

The purpose of this study was to assess parental and medical staff perceptions of the implementation of family-centered care during the surgical process at a pediatric hospital. Both children and parents experience hospitalization as a stressful process often characterized by painful, frightening medical procedures, interactions with strangers, and a loss of control and decision-making abilities. Medical staff members can play a vital role in alleviating parental distress by providing clear and consistent communication, support, and collaboration with parents throughout their child’s hospital care and recovery. Therefore, this study specifically sought to examine parental and medical staff members’ perceptions of the provision and importance of three types of social support: informational, emotional, and instrumental. This study also sought to examine the relationship between parental perceived provision and importance of social support and parental perceived stress. Qualitative questions were utilized to gather additional information regarding parents’ and medical staff members’ experiences throughout the surgical process. The sample for this study included 117 parents of surgical patients and 51 medical staff members (nurses, surgeons, and anesthesiologists) at a pediatric hospital in the southwestern United States. The quantitative data were analyzed using Mann-Whitney U Tests, Kruskal-Wallis Tests, and correlational analysis. Qualitative data were examined to identify major themes that have supported and contrasted with the quantitative results. The findings of this study revealed statistically significant differences between the perceived provision and importance of social support types among participant groups. Results also indicated statistically significant associations between parental perceptions of the provision and importance of social support type and parental perceived stress. These significant findings serve to inform care for families during the surgical process and guide future research in this area. / text

published_or_final_version / Public Health / Master / Master of Public Health

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / The objective of this project was to review skeletal survey reports and examine the differences in reporting of non-accidental trauma in patients with similar radiological findings. The overall purpose of this project is to develop a standardized reporting system for radiological findings suspicious for non-accidental trauma. Ten years’ worth of skeletal survey reports were obtained on over 1,500 pediatric patients. These reports were individually reviewed and their findings were categorized in a table separating findings suspicious for non-accidental trauma. After data collection, analysis was completed to inspect the consistency of reports amongst studies with similar fractures specifying non-accidental trauma. The comparison was made between reports containing long bone fractures, metaphyseal corner fractures, rib fractures, or any combination of these. It was concluded that there are inconsistencies in reporting of non-accidental trauma in reports with similar patterns of these fractures. We propose a Skeletal Survey – Reporting and Data System (SS-RADS) score which will help radiologist standardize their reporting methods for more consistent interpretations and clinical outcomes.

Introduction: Pediatric obesity prevention and management is a high priority for pediatric providers. Pediatric providers use evidence-based clinical guidelines to integrate the best current recommendations into practice. The contention of this inquiry is that while practice guidelines and obesity programs address the "who, what, when, where, and why" of pediatric obesity interventions, the guidelines fail to address the "how" of the process that bolsters adherence and attacks the high attrition rates of obesity management. Objective: The objective of this practice inquiry is to evaluate Prevention and Treatment for Pediatric Obesity: An Endocrine Society Clinical Practice Guideline Based on Expert Opinion using the Appraisal for Guidelines and Research and Evaluation (AGREE II) instrument and to investigate techniques to improve adherence to the lifestyle changes recommended in the guideline, by synthesizing the current research for using motivational interviewing with obese pediatric patients, and propose a plan for translating the intervention to measurable outcomes. Methods: Prevention and Treatment of Pediatric Obesity: An Endocrine Society Clinical Practice Guideline Based on Expert Opinion was evaluated using the AGREE II instrument. The current recommendations are detailed based on the findings of a review of the literature. Using the RE-AIM framework, recommendations are made to determine the translation potential for the use of motivational interviewing to improve adherence to lifestyle recommendations, thus improving the current clinical practice guideline. Results: Review of the Endocrine Society's CPG using the AGREE II instrument yielded an overall guideline quality rating of 6/7. The guideline is recommended for use with modifications to improve applicability. Integration of MI to the practice guideline and the use of the RE-AIM framework to improve uptake of the intervention is proposed to address the weaknesses in applicability revealed in the guideline evaluation. Conclusion: The CPG reviewed in this PI provides quality recommendations for the treatment and prevention of pediatric obesity. By integrating MI techniques and using the RE-AIM framework, pediatric providers may be able to bolster adherence to the guideline recommendations and ultimately improve clinical outcomes and impede the rising pediatric obesity rates. Future research should include evaluation of MI interventions in the pediatric clinical setting.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Background: Great strides have been made in childhood cancer treatment efficacy over the past two decades leading to improved survival rates, and now attention is being directed toward identifying and understanding complications that affect many of these patients as they reach adulthood. Obesity is a well‐recognized late effect that has many potential long‐term consequences some of which include cardiovascular disease, type II diabetes mellitus, dyslipidemia and even death. Materials/Methods: We conducted a retrospective chart review to determine the prevalence of obesity among survivors of pediatric brain tumors 5 years after the completion of therapy and compare this to the general pediatric population of the same age. We also sought to identify potential risk factors for the development of obesity among survivors of childhood brain tumors. Obesity was defined as a body mass index (BMI) greater than the 95th percentile for age and gender as defined by the most recent Center for Disease Control growth curves. Results: We identified 96 patients who met our inclusion criteria, however only 43 had follow‐up data at 5 years after the completion of therapy to be included in final analysis. Of 43 patients, 5 (11.63%) were obese 5 years after completion of therapy. The CDC sites general population obesity rates in three age groups: 2‐5 years (8.4% obesity rate), 6‐ 11 years (18% obesity rate), 12‐19 years (21% obesity rate). Using CDC guidelines, we found no significant difference between the obesity rate among the brain tumor survivor population for each age group and the general population, p‐values of 0.865, 0.865, and 0.249 respectively. Conclusion: Our small sample size was likely not adequate to find a significant difference between the two groups or identify risk factors associated with the development of obesity. Larger studies are needed to further examine the risk of obesity among pediatric brain tumor survivors and to identify risk factors associated with this late effect.

No description available.

Progressive Neuromuscular Diseases (PNDs) are relentless, debilitating, incurable diseases that cause nerves and muscles to atrophy. A large portion of the population who experience PNDs are adolescents. These adolescents progressively lose physical abilities and increasingly rely on caregivers at a time in their life when, paradoxically, normative adolescent development prescribes a move towards independence and autonomy. There is little research examining this experience from the adolescents’ perspectives. The purpose of this interpretive phenomenology study was to understand the experience of adolescents with PNDs when making decisions in relation to their health. Data collection consisted of 10 semi-structured interviews with 5 adolescents, 16-19 years of age, who were living with a PND (two interviews with each of the 5 participants). These interviews lasted an average of 60 minutes. Data were analysed using interpretive strategies, including the development of themes using exemplars, and paradigm cases. Findings revealed that the adolescents separated health decisions into two distinct categories, Big and Small, based upon level of perceived risk and physician involvement. Big referred to high-risk decisions, included physicians, and involved a medical/surgical procedure or intervention. Small referred to lower risk decisions, did not include physicians, and involved personal care. An expert emerged with each category of decision. In Big Decisions, the physician was perceived as the expert who made recommendations, provided information, and introduced the decision. In Small Decisions, the adolescent perceived himself as the expert. With Big Decisions, the physician expertise was typically respected, and the recommendations were followed. With Small Decisions, parents typically respected adolescent expertise. However, the adolescents commonly experienced not having their expertise respected by health professionals. In the context of Big and Small decisions, the theme Joint Ownership captured the sense that with the progressive loss of abilities and resulting dependence, the physical disability and illness were not experienced solely by the adolescent but by the adolescent and his parent(s). As the parent(s) and adolescent shared these experiences, the decisions, ownership of the physical body, and the responsibility for the care of the body also became shared. The findings suggest that health care professionals need to include the adolescents in the Small Decisions, and also acknowledge that adolescents may desire parental involvement in Big Decisions.

Juvenile idiopathic arthritis (JIA) is a common chronic disease of childhood. Children with JIA have lower peak oxygen consumption (V0₂ peak) than healthy children. In order to examine the cardiorespiratory response during aerobic exercise and the anaerobic to aerobic ratio (metabolic index), maximal exercise tests were performed in JIA subjects and age- and sex-matched controls (CON). Thirteen children aged 10 to 17 years with JIA and 9 CON participated. Peak powe r(watts, W) and total work (Joules, j) were determined with the Wingate anaerobic cycling test. VO₂ peak was measured by a maximal staged exercise test on a cycle ergometer. Cardiac output (CO, liters/minute) was measured with Doppler echocardiography. Arterial — mixed venous oxygen index (A-V0₂) and systemic vascular resistance (SVR) were calculated. Patient questionnaires included habitual activity, visual analog scale for joint pain and the childhood health assessment questionnaire. Physician completed data included active joint count and articular severity index. Compared to CON and reference age-matched norms, JIA subjects had lower aerobic fitness. VO₂ peak in JIA was 31.3 ml/min/kg (20.2-49.9), Z score -1.4 (-.06--2.4) and in CON was 47.9 ml/min/kg (32.7-54.1), Z score of -0.17 (-1.6-.87). [p = 0.013 V0₂ peak, p=0.011 Z score]. There were no significant differences in CO, A-V0₂ or SVR buttrends towards lower CO and higher SVR in JIA subjects were observed. During anaerobic exercise JIA subjects completed less total work (168.5 j/kg (107-252) JIA, 224 j/kg (180-248) CON, p=.036) but had similar peak power (9.7 W/kg (5.6-13.7) JIA, 11.3 W/kg (9.8-14.5) CON, p=.095). The metabolic index did not differ between JIA and CON. There was no significant correlation between disease activity, function and fitness measures in JIA subjects. Children with JIA have moderate impairments in aerobic fitness. CO and A-V0₂ during aerobic exercise did not significantly differ between JIA subjects and CON. Anaerobic fitness was mildly impaired with less total work completed by JIA subjects. Further research with larger numbers is required to determine factors contributing to limited fitness in JIA.

Rationale: Lower respiratory tract infections (LRTI) are a common cause of morbidity and mortality in children. Swallowing problems are also common in children. Aspiration is one outcome of swallowing dysfunction that may be a contributing factor to LRTI. Methods: Retrospective review of children undergoing videofluoroscopic swallow study was done to identify the prevalence and correlates of aspiration and LRTI. Results: Aspiration prevalence was 36.6%. Significant factors on univariate analysis included: developmental delay, LRTI, pneumonia, digestive tract anomalies, indigenous heritage, cough and congestion. With logistic regression, congestion and LRTI correlated with aspiration. Prevalence of LRTI was 42%. Using univariate analysis pneumonia, aspiration and indigenous heritage were significant. With logistic regression, respiratory issues and indigenous heritage correlated with LRTI. Conclusion: The etiology of LRTI is complex and multifactoral. Understanding the relationship between all factors is imperative given that current interventions are invasive and the untreated outcome can be progressive lung injury.