Feasibility and Acceptability of Ecological Momentary Assessment with High-Risk Suicidal Adolescents Following Acute Psychiatric Care.

Objective: The study purpose was to examine the feasibility and acceptability of intensive ecological momentary assessment (EMA) among high-risk adolescents with suicidal thoughts and behaviors following discharge from acute psychiatric care.Method: Fifty-three adolescents, 12-18 years old, and their parents, were recruited following discharge from acute psychiatric care for suicide risk. The study included a baseline assessment (adolescent and parent), 28 days of EMA surveys (5x per day) and wrist actigraphy (adolescent), and an interview at the end of the 28-day monitoring period (adolescent). Adolescents' outpatient clinicians were also surveyed about the study.Results: Study feasibility was indicated by a reasonable enrollment rate, high adherence to wearing the actigraphy device, and good adherence to EMA surveys (highest in the first week with significant drop-off in subsequent weeks). Adolescents reported their overall experience in the study was positive, the questions were understandable, their responses to questions were generally accurate, and the surveys were minimally burdensome. The study procedures did not appear to be iatrogenic; suicide attempts and rehospitalizations were not study related and occurred at a rate comparable to other adolescents at the recruitment site. Adolescents' clinicians reported that the study was somewhat positive and minimally burdensome for them, and somewhat positive for their patients and families.Conclusions: This study demonstrated that intensive EMA designs are feasible and acceptable among high-risk suicidal youth following acute psychiatric care. Specific procedures are provided for keeping adolescents safe during intensive EMA studies, including detailed information about the risk and safety monitoring plan.

Effects of Short-Term Exercise Training With and Without Milk Intake on Cardiometabolic and Inflammatory Adaptations in Obese Adolescents.

There is some evidence that a combination of factors can reduce inflammation and associated metabolic risk factors. We studied the early cardiometabolic and inflammatory adaptations to a short-term exercise intervention with and without milk in obese adolescents. Fifty-four adolescents were randomized to consume milk post exercise (MILK) or a carbohydrate beverage (CONT) during one-week of daily exercise. Insulin levels were not different between the groups post training. Glucose was reduced over time in both groups (-9 ± 13 mg/ dl MILK and -6 ± 14 mg/dl CONT, p < .05) but not different between groups. There was a greater decrease in mean arterial pressure (MAP) in the MILK group (-3 ± 6 mmHg MILK vs. 2 ± 7 mmHg CONT, p < .04). Milk provided postexercise did not affect C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) or interleukin-6 (IL-6). The exercise intervention led to an increase in TNF-α in both groups (0.27 ± 0.7 pg/ml MILK and 0.48 ± 0.6 pg/ml CONT, p < .001). The early adaptations to a short-term exercise intervention in obese adolescents include a reduction in MAP and an increase in some inflammatory markers.

Mindfulness-based group therapy: Impact on psychiatrically hospitalized adolescents.

The practice of mindfulness has long been incorporated into psychotherapy. Research on the therapeutic benefits of mindfulness exists within adult populations, and emerging empirical evidence demonstrates the benefit of such practices in the treatment of adolescents in both clinical and non-clinical settings. However, there are extremely limited data on the practice of mindfulness with adolescents in a psychiatric hospital. The iMatter ( Improve Mindful ATTention, Enhance Relaxation) group is a manualized program developed to provide adolescents on a short-term psychiatric inpatient unit with an opportunity to learn and practice relaxation strategies, mindfulness exercises, and simple yoga poses. Mindfulness skills are taught in the context of the group and include self-observation of thoughts and feelings, breathing exercises, self-validation of one's experience, loving-kindness toward self, non-judgmental stance toward self, and acceptance and observation of change within self. Participants included 65 adolescents aged 13-17 years ( M = 15.06, standard deviation ( SD) = 1.34) who took part in at least one session of the iMatter intervention. Improvements in self-reported mood were evident following participation in a mindfulness group. Also, participants' heart rate significantly decreased following participation in two groups. Future directions include improved integration of mindfulness into the milieu and other unit programming. Furthermore, comparing self-reported mood and physiological measures from this sample to findings obtained for other unit groups will further clarify the impact of the iMatter intervention.

Circulating endothelial cells in children: role of fitness, activity, and adiposity.

PURPOSE: Circulating endothelial cells (CEC) are thought to be useful biomarkers of endothelial dysfunction and overall cardiovascular health. The extent to which CEC are influenced by fitness, physical activity, and adiposity in youth remains unknown, as they have seldom been examined in the pediatric population. This study assessed resting levels of CEC in boys and girls of different chronological and biological age and explored the relationship between these cells and aerobic fitness, physical activity, and adiposity. METHODS: Seventy-five children (39 males; median [interquartile range], age = 14.4 [5.8]) completed two study visits. During the first visit, basic anthropometric data were collected and biological age was calculated. Peak mechanical power (Wpeak) was determined using the McMaster All-Out Continuous cycling test. Participants then wore an accelerometer over a 7-d period to assess habitual levels of moderate-to-vigorous physical activity. During visit 2, percent body fat (%BF) was assessed by dual-energy x-ray absorptiometry. A fasted blood sample was also collected from which concentrations of CEC, identified as CD31CD34CD45CD133, were quantified by flow cytometry. RESULTS: No differences were seen in CEC by sex, chronological age, or biological age. The median (interquartile range) CEC concentration was 32.3 × 10 (63.0 × 10), representing 1.3% (2.7%) of collected peripheral blood mononuclear cells. CEC concentration was associated with Wpeak normalized to lean body mass (r = 0.36, P < 0.01) and time spent in moderate-to-vigorous physical activity (r = -0.27, P = 0.02). No relationship was observed between CEC and %BF. CONCLUSION: Healthy children demonstrate relatively low concentrations of CECs. Because CEC represent a population of mature endothelial cells shed from the intima after irreversible damage, they may be more reflective of recent physical activity levels rather than fitness or level of adiposity.

Impact of pediatric mental health screening on clinical discussion and referral for services.

OBJECTIVE: This study discusses the impact of mental health screening in pediatric primary care on the management of mental health concerns. METHODS: Youth aged 11 years and their parents completed the Pediatric Symptom Checklist and chart reviews were used to gather information about discussion of mental health concerns and connection with mental health services. The study design was a post-intervention study with a concurrent comparison group of youth aged 12 years who were not offered a screening. The χ(2) or Fisher's exact tests and logistic regression were used to compare groups on outcome variables. RESULTS: Parents who completed a mental health screening for their child were more likely to be referred and attend mental health services, attend a psychiatrist appointment, and discuss their concerns with the primary care provider compared with the comparison group. CONCLUSIONS: Screening by parents improves detection of problems and fosters conversations with providers and subsequent connection with services.

Testing the theoretical framework of the COPE program for mothers of critically ill children: an integrative model of young children's post-hospital adjustment behaviors.

OBJECTIVE: To test a theoretical model examining processes through which a parent-focused educational-behavioral intervention [Creating Opportunities for Parent Empowerment (COPE)] relates to children's post-hospital adjustment problems. METHODS: Mothers (n = 143) and their 2-7-year-old children, unexpectedly hospitalized in two pediatric intensive care units, were randomized to COPE or control conditions. Maternal measures included parental beliefs, anxiety, negative mood, and child adjustment 3 months post discharge. Observers rated maternal support of their children during hospitalization. RESULTS: Structural equation modeling suggested that the model tested provided a reasonable fit to the data [chi2 (97 df) = 129.43; p = .016; root mean square error of approximation = .048; comparative fit index = .95]. COPE effects on children's post-hospital externalizing behaviors were indirect, via associations with parental beliefs and maternal negative mood state. Furthermore, COPE participation was associated with more maternal support of their children, which was also associated with less internalizing and externalizing behaviors 3 months post discharge. CONCLUSION: Implementing COPE may help avert future mental health problems in this high risk population. Understanding the processes by which an already empirically validated program relates to child outcomes is likely to aid clinicians and administrators in the widespread uptake of the COPE program.

Overweight children reduce their activity levels earlier in life than healthy weight children.

OBJECTIVE: To determine differences in the time overweight and nonoverweight youth spend on light, moderate, hard, and very hard activity plus gender and age differences in activity patterns. DESIGN AND SETTING: This study was a cross-sectional design in a primary care hospital. PARTICIPANTS: A total of 197 children and adolescents (4-16 years) participated. The overweight group (n = 107) were on a waiting list for an obesity treatment program and were defined as overweight, with a body mass index >95th percentile, and the nonoverweight group (n = 90) were volunteers recruited via advertisements and had a body mass index <75th percentile. INTERVENTIONS AND OUTCOME MEASUREMENTS: To determine activity patterns and perception of activity level, an interview was conducted with the child and a parent using a validated 7-day recall. Body fat was measured with bioelectrical impedance. RESULTS: There was a negative correlation between adiposity and total amount of activity performed, with the amount of moderate activity the best predictor of obesity. Girls did less activity than boys whether overweight or not. Between the ages of 4 and 7 years, overweight and nonoverweight subjects did similar amounts of activity. In the older subjects, the activity of the overweight was less than in nonoverweight. The overweight subjects perceived themselves to be just as active as others their same age and sex. CONCLUSIONS: Clinicians need to be aware that overweight children and adolescents are less active than nonoverweight children at an earlier age, particularly females, but feel that their activity level is similar to that of nonobese children.

Food away from home, sugar-sweetened drink consumption and juvenile obesity.

OBJECTIVE: To identify if particular foods or food groups may be associated with obesity in children and adolescents and to determine if consuming food away from home (FAFH) has an effect on the nutritional quality of their diets. DESIGN: One-year cross-sectional study. SETTING/SUBJECTS: The obese subjects (n = 91) were on the waiting list for a hospital-based weight control treatment program. The non-obese subjects (n = 90) were recruited from community advertisements. MEASURES OF OUTCOME: Information on food intake was obtained using the dietary history method by a Registered Dietitian. Body fat was determined by bioelectrical impedance analysis. RESULTS: Obese children and adolescents consumed significantly more servings of meat and alternatives, grain products, FAFH, sugar-sweetened drinks and potato chips which contributed to a higher calorie, fat and sugar intake compared to non-obese children and adolescents. Sugar-sweetened drinks were only significantly greater in boys. The consumption of meat servings, sugar-sweetened drinks and FAFH was positively correlated with percent body fat. The frequency of food consumed outside of the Canada's Food Guide To Healthy Eating was not different between the two groups. CONCLUSIONS: Obese children and adolescents need to limit their access to food consumed away from home and sugar-sweetened drinks as there is a relationship between these foods and body fatness.