Efficacious interventions for improving the transition readiness of adolescents and young adult patients with chronic illness: A narrative review of randomized control trials assessed with the transition readiness assessment questionnaire.

Objective: We inspected efficacious interventions to improve the transition readiness of adolescent and young adult patients with childhood-onset chronic illnesses using the Transition Readiness Assessment Questionnaire (TRAQ). Methods: Our narrative review was conducted on randomized control studies assessed with TRAQ for outcome measurement before and after the interventions. We included all patients with chronic diseases. We searched eight electronic database(s): Allied and Complementary Medicine Database (AMED) Allied and Complementary Medicine, BioSciences Information Service of Biological Abstracts (BIOSIS) Previews, Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, Embase, Ichu-shi, Medline, and Web of Science. The text words for the search of data sources were as follows: "("transition readiness assessment questionnaire" OR TRAQ) AND 2011/01:2022/06[DP] AND (clinical AND trial OR clinical trials OR clinical trial OR random* OR random allocation)." More studies were identified from the references in our reported study. This data set was independently cross-checked by two reviewers. Results: We identified 261 reports and collected three articles. The target diseases were type-1 diabetes, congenital heart disease, cystic fibrosis, and inflammatory bowel disease. All the studies excluded patients with intellectual disabilities. The age of the participants was distributed between 12 and 20 years. Nurse-provided web-based intervention of transition readiness was constructed using digital resources in two studies. The intervention ranged from 6 to 18 months. All the interventions were efficacious in improving transition readiness assessed with TRAQ scores, except for the self-advocacy score. Conclusions: We obtained three randomized control studies with TRAQ for outcome measurement. In two studies, web-based and nurse-led organized interventions were shown to improve transition readiness.

Early intervention for psychosomatic symptoms of adolescents in school checkup.

BACKGROUND: The purpose of this study was to evaluate the efficacy of early medical intervention for psychosocial problems detected in adolescents in a school health checkup, with the broader goal of prevention of these problems in adolescents. METHODS: The Questionnaire for Triage and Assessment with 30 items score and scores for five subscales (physical symptoms, depression symptoms, anxiety symptoms, self-efficacy, and family function), and an investigation of lifestyle were determined in a school health checkup for 5th grade elementary to 3rd grade junior high school students. Forty-three children were found to be at high risk for psychosomatic disorder, of whom 18 then received a medical intervention (early intervention group) and 25 did not (non-intervention group). Fifty-seven children (outpatient group) treated for psychosomatic disorder for ≤3 months were also included in the study. The Questionnaire for Triage and Assessment with 30 items (QTA30) was completed by all participants every 3 months for 1 year and scores were compared among the groups. RESULTS: In the early intervention group, total Questionnaire for Triage and Assessment with 30 items scores; physical, depression, and anxiety symptoms; and unstable relationships with friends and teachers at school all significantly improved after 1 year compared to the first survey. None of these items improved in the non-intervention group, while the outpatient group had gradual improvement in all scores. Family function scores in the early intervention group improved over time, whereas those in the non-intervention group worsened. CONCLUSIONS: Early detection of children at high risk for psychosomatic disorder at a school health checkup and early medical intervention were useful for prevention of psychosomatic disorder in adolescents.

Psychogenic fever and postural tachycardia syndrome among school-aged children and adolescents with fever of unknown origin.

BACKGROUND: Although fever is a common symptom in pediatric practice, its origin is often unknown in pediatric patients. Psychogenic fever is a stress-related, psychosomatic disease observed especially in young women. This study aimed to estimate the prevalence of psychogenic fever in pediatric patients with fever of unknown origin by surveying the medical records of school-aged children and adolescents. METHODS: The study subjects included 47 patients aged 6-15 years who visited the Department of Pediatrics in Kansai Medical University Medical Center between January 2006 and December 2020 with fever of unknown origin. Data on age, sex, final estimated diagnosis, and comorbid psychosocial issues were collected from the medical records. RESULTS: The study was composed of 47 patients, including 22 male and 25 female patients (male/female ratio, 1:1.36). The mean age was 10.1 (standard deviation, 2.4) years for boys and 11.6 (standard deviation, 2.7) years for girls (p = .047). The final estimated diagnoses were psychogenic fever, physical disorder, infection of unknown origin, and miscellaneous in 18, 12, 12, and 5 patients, respectively. The most common comorbidity in these pediatric patients with psychogenic fever was postural tachycardia syndrome. CONCLUSION: Psychogenic fever was a common cause of fever of unknown origin in pediatric patients, and postural tachycardia was prevalent among children with psychogenic fever. Enhanced sympathetic response to stress might play an important role in both psychogenic fever and postural tachycardia.

Eye gaze differences in school scenes between preschool children and adolescents with high-functioning autism spectrum disorder and those with typical development.

BACKGROUND: Children with autism spectrum disorder (ASD) may experience difficulty adapting to daily life in a preschool or school settings and are likely to develop psychosomatic symptoms. For a better understanding of the difficulties experienced daily by preschool children and adolescents with ASD, this study investigated differences in eye gaze behavior in the classroom environment between children with ASD and those with typical development (TD). METHODS: The study evaluated 30 children with ASD and 49 children with TD. Participants were presented with images of a human face and a classroom scene. While they gazed at specific regions of visual stimuli, eye tracking with an iView X system was used to evaluate and compare the duration of gaze time between the two groups. RESULTS: Compared with preschool children with TD, preschool children with ASD spent less time gazing at the eyes of the human face and the object at which the teacher pointed in the classroom image. Preschool children with TD who had no classroom experience tended to look at the object the teacher pointed at in the classroom image. CONCLUSION: Children with ASD did not look at the human eyes in the facial image or the object pointed at in the classroom image, which may indicate their inability to analyze situations, understand instruction in a classroom, or act appropriately in a group. This suggests that this gaze behavior of children with ASD causes social maladaptation and psychosomatic symptoms. A therapeutic approach that focuses on joint attention is desirable for improving the ability of children with ASD to adapt to their social environment.

Late bedtime reflects QTA30 anxiety symptoms in adolescents in a school checkup.

BACKGROUND: In adolescence, physical symptoms may develop due to psychosocial problems but such problems are not fully evaluated in school medical checkups. The aim of this study was to compare lifestyle factors with psychosomatic symptoms in adolescents using the subscales of the Questionnaire for Triage and Assessment with 30 items (QTA30) in school health checkups. METHODS: The QTA30 was used in checkups for 3,414 students from the fifth grade of primary school to the third grade of junior high school in south Wakayama prefecture. The QTA is a self-completed questionnaire with five subscales of physical symptoms, depression symptoms, self-efficacy, anxiety symptoms, and family function. Each subscale is divided into three groups of clinical, borderline, and healthy, based on the subscale score. Subscale scores were compared with lifestyle items of gender, grade, habits, life events, and school attendance. RESULTS: The clinical rate for all subscales was significantly higher for a higher grade (P < 0.001). Anxiety symptoms were correlated with physical symptoms (r = 0.560). Anxiety and physical symptoms were significantly higher for students who went to bed at a later time with no absences in the last month and who had problems with friends and teachers (both P < 0.001). Family function correlated with self-efficacy (r = 0.418) but not with other subscales. Study time was most related to self-efficacy (P < 0.001). CONCLUSIONS: The QTA30 subscale scores facilitated detection of psychosomatic stress and latent risks of psychosomatic disease at an early stage. Thus, the use of the QTA30 in a school medical checkup may permit early intervention for psychosomatic stress in adolescents.

Utility of the QTA30 in a school medical checkup for adolescent students.

BACKGROUND: In adolescence, physical symptoms may develop due to psychosocial problems, but such problems are not fully evaluated in school medical checkups. The aim of the study was to compare the characteristics of students with high and low scores on the Questionnaire for Triage and Assessment with 30 items (QTA30) in a school health checkup. METHODS: The QTA30 (a self-completed questionnaire) was used in checkups for 3,414 students from the 5th grade of primary schools to the 3rd grade of junior high schools in south Wakayama Prefecture. The students were divided into groups with high (QTA30 ≥ 37) and low (QTA30 < 37) risk for psychosomatic disorder. Eleven items, including gender, grade, lifestyle habits, and life events, were compared between these groups, and in subgroups with and without recent absence from school. RESULTS: The QTA30 response rate was 87.9%. The high-risk group had significantly more 3rd grade students (P< 0.001), females (P< 0.001), problems with teachers or friends (P< 0.001), and experience of bullying (P< 0.001), in addition to game playing for ≥2 h (P< 0.001), late bedtime (P< 0.001), and many absences (P< 0.001). Students in the high-risk group with no absences for 1 month regardless of age still had a late bedtime and problems with friends, and 76.4% of the high-risk students had not visited a medical institution. CONCLUSIONS: Use of the QTA30 facilitated detection of psychosomatic stress in school medical checkups, with latent risks of truancy detectable at an early phase. The QTA30 may thus be useful in early intervention for psychosomatic stress of adolescents.

Spatiotemporal characteristics of gaze of children with autism spectrum disorders while looking at classroom scenes.

Children with autism spectrum disorders (ASD) who have neurodevelopmental impairments in social communication often refuse to go to school because of difficulties in learning in class. The exact cause of maladaptation to school in such children is unknown. We hypothesized that these children have difficulty in paying attention to objects at which teachers are pointing. We performed gaze behavior analysis of children with ASD to understand their difficulties in the classroom. The subjects were 26 children with ASD (19 boys and 7 girls; mean age, 8.6 years) and 27 age-matched children with typical development (TD) (14 boys and 13 girls; mean age, 8.2 years). We measured eye movements of the children while they performed free viewing of two movies depicting actual classes: a Japanese class in which a teacher pointed at cartoon characters and an arithmetic class in which the teacher pointed at geometric figures. In the analysis, we defined the regions of interest (ROIs) as the teacher's face and finger, the cartoon characters and geometric figures at which the teacher pointed, and the classroom wall that contained no objects. We then compared total gaze time for each ROI between the children with ASD and TD by two-way ANOVA. Children with ASD spent less gaze time on the cartoon characters pointed at by the teacher; they spent more gaze time on the wall in both classroom scenes. We could differentiate children with ASD from those with TD almost perfectly by the proportion of total gaze time that children with ASD spent looking at the wall. These results suggest that children with ASD do not follow the teacher's instructions in class and persist in gazing at inappropriate visual areas such as walls. Thus, they may have difficulties in understanding content in class, leading to maladaptation to school.

The transition of adult patients with childhood-onset chronic diseases from pediatric to adult healthcare systems: a survey of the perceptions of Japanese pediatricians and child health nurses.

BACKGROUND: Advances in medical science have enabled many children with chronic diseases to survive to adulthood. The transition of adult patients with childhood-onset chronic diseases from pediatric to adult healthcare systems has received attention in Europe and the United States. We conducted a questionnaire survey among 41 pediatricians at pediatric hospitals and 24 nurses specializing in adolescent care to compare the perception of transition of care from pediatric to adult healthcare services for such patients. FINDINGS: Three-fourths of the pediatricians and all of the nurses reported that transition programs were necessary. A higher proportion of the nurses realized the necessity of transition and had already developed such programs. Both pediatricians and nurses reported that a network covering the transition from pediatric to adult healthcare services has not been established to date. CONCLUSIONS: It has been suggested that spreading the importance of a transition program among pediatricians and developing a pediatric-adult healthcare network would contribute to the biopsychosocial well-being of adult patients with childhood-onset chronic disease.