Evaluation of a nurse-led multi-component transition program for adolescents with congenital heart disease.

OBJECTIVE: To evaluate the effectiveness of the transition program for adolescents with congenital heart disease (CHD) 'Transition With a Heart' (TWAH) on disease-related knowledge, quality of life (QoL), transition experiences, and gaps in follow-up. METHODS: A study with pre-posttest and control group (post-test) using consecutive sampling, including adolescents with moderate to severely complex CHD, without intellectual disability, aged≥ 12 y, and parents. After weighting, t-tests were performed. A multivariable regression analysis explored the outcomes' determinants. RESULTS: In the intervention group, 28 adolescents and 25 parents were included, and 53 adolescents and 18 parents as controls. Adolescents' knowledge significantly increased after completing TWAH (from 59.8% to 75.7%;p < 0.01). Their knowledge was positively correlated with TWAH (ß = +13.3;p < 0.01). Adolescents' transition experiences were also positively related to TWAH (general experience: ß = +5.5;p < 0.01; transfer satisfaction: ß = +0.8; p < 0.01). Adolescents' QoL was mainly determined by CHD complexity and not by TWAH. No one showed gaps in follow-up. TWAH was not associated with parents' transition experiences. CONCLUSION: Implementing TWAH substantially improved adolescents' disease-related knowledge and transition experiences. PRACTICE IMPLICATIONS: The results regarding transition experiences need to be confirmed by further research. The TWAH design with the person-tailored educational program, skills training, and the transition coordinator can be used in settings with other chronic diseases.

Development of a transition program for adolescents with congenital heart disease.

Thanks to advances in care, most children with congenital heart disease nowadays survive into adulthood. The majority of patients remain at high risk for future complications. Hence, life-long follow-up is mandatory. Care needs of patients evolve, especially when reaching adulthood. A structured transition period to adult care is advocated. Currently, a fully detailed and structured transition program is not available for patients with congenital heart disease. The aim is to describe the development and design of a multicomponent transition program for adolescents with congenital heart disease, called "Transition with a heart." Transition with a heart was developed based on the Dutch program "On your own feet," starting at the age of 12 years and continuing after transfer. The most vital core components include a general and individualized flowchart, adolescent-centered communication, a joined transfer consultation, and an appointed transition coordinator. Adolescents are gradually informed about their condition and potential late consequences in adult life and stimulated to take medical care in their own hands.Conclusion: Transition with a heart is a practical, multicomponent, comprehensive transition program developed to cover the essential aspects of transitional care for adolescents with congenital heart disease (i.e., continuity of care, disease knowledge, and self-management skills). Interventions were selected from the highest sources of scientific evidence currently available.Clinical trial registration: Not applicableWhat is Known:• Transition towards adult life and health care is a complex process, requiring careful patients' guidance. Various task forces have described the need and potential benefits of transition programs in young people with chronic conditions. Details about the practical development and content of such programs in congenital heart disease are, however, currently lacking.What is New:• This method paper presents the development and design of a person-centered multicomponent transition program for adolescents with congenital heart disease comprising interventional components covering the most important aspects of transitional care: promoting autonomy, disease knowledge, and continuity of care.

Personality pathology comorbidity in adult females with eating disorders.

Personality pathology is examined in 100 female in-patients diagnosed with eating disorders. The Eating Disorder Inventory-II and the NEO-PI-R were self-administered and personality pathology was assessed using a structured interview. Clinicians additionally evaluated patients' global functioning. The results indicated sizeable personality disorder comorbidity, and two dimensions of personality pathology, for example, an internalizing and an externalizing factor, could be identified. Patients' global functioning was primarily associated with dimensions of personality pathology, but not with eating disorder symptoms. Assessment and therapeutic interventions should focus on this co-occurring pathology in order to improve patients' functioning.

Weight parameters and pathological eating as predictors of obesity treatment outcome in children and adolescents.

OBJECTIVE: The current study investigated weight parameters and pathological eating as predictors of treatment outcome in obese youngsters. METHOD: Obese youngsters (N=132) were examined before participating in an obesity treatment program. Weight loss was measured during and at the end of treatment. RESULTS: Baseline adjusted BMI, restrained eating style and weight loss after 4 months of treatment positively predicted weight loss at the end, whereas larger weight loss after 1 month of treatment predicted less total weight loss. Lower baseline adjusted BMI was associated with more drop-out whereas subjective binge eating was positively related to program completion. CONCLUSION: Specific weight and eating pathology parameters affected positive as well as negative obesity treatment outcome. Identifying more pre-treatment predictors for drop-out can ameliorate our treatment approach.

Loss of control over eating in overweight youngsters: the role of anxiety, depression and emotional eating.

The current study investigated loss of control (LC) over eating and the role of anxiety, depression and emotional eating in a sample of both treatment seeking (N = 115) and non-treatment seeking (N = 73) overweight youngsters (aged 8-18) using a semi-structured clinical interview and self-report questionnaires. It was found that treatment seekers reported twice as much LC (40%) compared to non-treatment seekers (21%). Cross-sectional prediction models indicated that increased anxiety was associated with emotional eating and LC. Emotional eating tended to mediate the relationship between anxiety and LC. Increased depression was associated with emotional eating but not with LC. Especially overweight treatment seekers turn out to be at risk for LC. Because LC may develop as a result of inadequate coping with negative emotions like anxiety, obesity treatment should focus on teaching more effective coping strategies. Longitudinal research is recommended to further elaborate affect regulation and LC.

Psychological disorder, symptom severity and weight loss in inpatient adolescent obesity treatment.

OBJECTIVE: This study aimed to investigate whether psychological disorders and symptom severity hamper weight loss in obese adolescents and explored the effect of evidence-based adolescent obesity treatment on psychological disorders and symptom severity. METHOD: Participants were 66 adolescents admitted for a 10-month obesity treatment programme. At the start of treatment both clinical interviews and self-report questionnaires were administered. Weight loss was registered at several time points. Half of the sample was invited to complete questionnaires and be interviewed once again at the end of the programme. RESULTS: Baseline degree of overweight was the strongest predictor of weight loss. The presence of at least one psychological disorder appeared a negative predictor of weight loss after four months. At post-test, a decrease in eating, shape and weight concern and binge eating episodes was demonstrated. A similar trend was found for internalizing symptoms. All eating disorders resolved, but a substantial number of adolescents still suffered from psychological disorders at the end of treatment. CONCLUSION: During inpatient obesity treatment, youngsters who are more severely obese lose most weight. In girls and in adolescents suffering from psychological disorders, long-term care should be the aim to prevent an experience of failure. From a psychological health perspective, the inclusion of psychotherapy during inpatient obesity treatment for adolescents suffering from psychiatric disorders is worth considering. All together, the findings of this study demonstrate the importance of adopting both a medical and a psychological perspective on obesity (treatment) in youth.

Psychiatric disorders and symptom severity in referred versus non-referred overweight children and adolescents.

BACKGROUND: This study aimed firstly to investigate whether youngsters referred for overweight treatment differ from non-referred overweight youngsters on the prevalence of psychiatric disorders and psychological symptoms. Secondly, the potentially moderating role of age, gender, socio-economic status and degree of overweight in the association of referral status and mental disorder in overweight youth was explored. METHODS: Participants were 155 overweight youngsters enrolled in an obesity treatment programme (mean age = 13.76; mean BMI = 33.99) and 73 non-referred overweight youngsters (mean age = 13.74; mean BMI = 27.35). The Structured Clinical Interview for DSM-IV-Childhood version and the Child version of the Eating Disorder Examination were administered and participants filled out the Children's Depression Inventory, the Spence Children's Anxiety Scale and the Youth Self Report. Parents were asked to complete the Child Behavior Checklist. RESULTS: In the referred group 37.50% and in the non-referred group 23.29% of the participants met criteria for at least one mental disorder. In both groups, anxiety disorders were most prominent. Overall, a higher prevalence of mental disorders was found in the referred group. Referred youth displayed significantly more 'full blown' eating disorders and binge eating than non-referred youngsters and exhibited a significantly greater severity of self- and parent-reported internalizing symptoms. Referral was also associated with a significantly higher degree of overweight and significantly lower SES. After controlling for these pre-existing differences in degree of overweight and SES, only the greater severity of parent-reported internalizing symptoms in referred youth remained significant. Older age was generally predictive for the presence of mental disorders and in the non-referred group SES was positively associated with psychiatric disorder. CONCLUSIONS: A substantial proportion of overweight youngsters suffer from mental disorders. Referral status and age are associated with the presence of psychopathology. However, differences between referred and non-referred youngsters are not as pronounced as expected on the basis of earlier research in the field.

Are two informants better than one? Parent-child agreement on the eating styles of children who are overweight.

AIM: It is currently unknown to what extent the view of a child with overweight on its' own eating behaviour converges with parental perception regarding this behaviour and how parent-child agreement is influenced by overweight status and age. METHOD: Youngsters (N = 498; range 7-15 years; 37% boys) referred for weight treatment to an outpatient University centre filled in the Dutch Eating Behaviour Questionnaire-child version (DEBQ-child version; Van Strien & Braet, unpublished work), prior to treatment, while their parents reported on their child's eating behaviour by completing the DEBQ-parent version (Braet & Van Strien, 1997). RESULTS: Parents scored significantly higher when reporting on the emotional eating and external eating behaviour of their child, while they scored lower for restrained eating (all p < 0.001). Comparisons between the subscales of the DEBQ-parent version and the DEBQ-child version revealed significant positive correlations of r = 0.45 for emotional eating, r = 0.35 for external eating and r = 0.36 for restrained eating (all p < 0.01); convergence is lowest for the age group younger than 10 (p < 0.05). Both versions of the DEBQ displayed low correlations with the degree of overweight of the child. DISCUSSION: Parents and children displayed moderate to good agreement with regard to emotional eating, external eating and restrained eating. However when only one perspective can be assessed, possible biases must be taken into account. In that case, the use of appropriate age-specific norms is indicated.