Effects of Trauma and Anxiety on Adherence in Pediatric Type 1 Diabetes.

Background: Psychiatric factors such as depression, anxiety, and life stressors have been shown to negatively affect diabetes self-management and A1C in children and adolescents. However, less is known about how trauma exposure and symptoms of post-traumatic stress disorder (PTSD) may affect type 1 diabetes. Objectives: To determine the rates of trauma exposure and PTSD symptoms in patients aged 7-21 years with type 1 diabetes and to examine the relationships among trauma exposure, PTSD, anxiety, depression, and diabetes self-management. Methods: Patients underwent standardized psychiatric screening questionnaires during clinic visits. A1C at goal was defined as <7.0%, and behavioral adherence was defined as specific parameters of blood glucose monitoring. χ2 and Fisher exact tests were used to assess the relationships among trauma, PTSD, anxiety, and behavioral adherence. ANOVA was conducted to examine group differences between A1C and the presence of suicidal ideation. Results: Of the participants, 38.4% (n = 99, mean age 13.8 ± 3.5 years, 51.5% female) had trauma symptoms and functional impairment concerning for PTSD. Rates of trauma secondary to accidental injury, medical traumatic stress, natural disaster, and witness to family violence were 28.3, 22.2, 10.1, and 6.1%, respectively. Neither PTSD nor anxiety nor depression symptoms were associated with behavioral nonadherence (P = 0.546, P = 0.337, and P = 0.697, respectively), but the subscales for significant school avoidance and generalized anxiety disorders were associated with behavioral nonadherence (P = 0.023 and P = 0.032, respectively). Those who reported suicidal ideation had higher mean A1C than those who did not (A1C 8.9 vs. 8.3, P = 0.047). Conclusion: Although trauma was common among youth with type 1 diabetes, neither trauma nor PTSD was associated with changes to self-management. However, certain forms of anxiety and suicidal ideation were associated with poor self-management and higher A1C, respectively.

Training Needs Assessment Survey in Pediatric Consultation-Liaison Psychiatry.

OBJECTIVE: Despite growing recognition of how curriculum modules can benefit child and adolescent psychiatry (CAP) training, there are few standardized teaching resources for pediatric consultation-liaison psychiatry (PCLP). A Special Interest Group (SIG) of the American Academy of Child and Adolescent Psychiatry Physically Ill Child Committee (PICC) conducted a needs assessment to establish interest in, and availability of, a library of online, self-paced learning modules specific to PCLP. METHOD: An email needs assessment survey was distributed to the PICC listserv in the fall of 2019 with four core areas of inquiry: (1) clinical service description, (2) teaching barriers, (3) interest in curriculum resources, and (4) interest in evaluation resources. RESULTS: Respondents were representative of typical academic PCLP programs. The response rate was 28% (n = 39). Programs endorsed barriers to teaching including high service obligations and limited protected teaching time. All respondents indicated that they would utilize high-quality, online learning modules. Psychiatric complications of medical illness, catatonia, and delirium were identified as priority topics in the care of pediatric patients with comorbid medical conditions. CONCLUSIONS: There are currently no published educational studies regarding the training needs for PCLP programs, even among tertiary care academic facilities. This training needs assessment is the first step in establishing a national PCLP training curriculum. New paradigms to develop standardized curriculum resources for PCLP are needed.

Identifying Opioid Use Disorder from Longitudinal Healthcare Data using a Multi-stream Transformer.

Opioid Use Disorder (OUD) is a public health crisis costing the US billions of dollars annually in healthcare, lost workplace productivity, and crime. Analyzing longitudinal healthcare data is critical in addressing many real-world problems in healthcare. Leveraging the real-world longitudinal healthcare data, we propose a novel multi-stream transformer model called MUPOD for OUD identification. MUPOD is designed to simultaneously analyze multiple types of healthcare data streams, such as medications and diagnoses, by attending to segments within and across these data streams. Our model tested on the data from 392,492 patients with long-term back pain problems showed significantly better performance than the traditional models and recently developed deep learning models.

Adverse Childhood Experiences, Tobacco Use, and Obesity: A Crowdsourcing Study.

Background: Exposure to adverse childhood experiences (ACEs) increases health risk behavior in adulthood and is a risk for premature mortality. For example, ACEs are associated with both tobacco smoking and obesity, which remain significant health challenges for many adults, despite widespread knowledge about the risks. Objective: The present investigation used a novel online crowdsourcing platform (Amazon.com mechanical turk) to study the relationship between ACEs and later tobacco smoking and obesity. Methods: Participants were recruited based on smoking (n = 74 smokers; n = 75 nonsmokers) and stratified based on obesity (n = 52 BMI ≥ 30; n = 97 BMI < 30). Participants had no recent history of other substance use, except alcohol. The relationship between ACE score and smoking and obesity categories was analyzed using logistic regression. Results: The average age of the sample was 38.6-years old and was mostly female (66.4%), employed (82.6%) and college educated (63.1%). Those with 4+ ACEs had a significantly greater odds of cigarette use. Any ACEs exposure was associated with a significantly greater odds of obesity. Conclusions/Importance: Findings are concordant with previous studies and suggest crowdsourcing is a viable platform for studying ACEs and health behavior. Access to large samples and specific populations provided by crowdsourcing could help examine theoretical models about how exposure to ACEs could be connected to later adoption of high-risk behaviors such as tobacco cigarette smoking and obesity.

Identifying the risk of suicide among adolescents admitted to a children's hospital using the Ask Suicide-Screening Questions.

PROBLEM: Suicides are now the second leading cause of death among teenagers and young adults, 10-24. Many people who die by suicide visit a healthcare provider in the months before their death. Unfortunately, many healthcare clinicians do not routinely screen for mental health concerns such as suicide risk even though the American Academy of Pediatrics recommends screening adolescents for suicide risk. METHODS: The Ask Suicide-Screening Questions (aSQ), a four-question screening instrument, was administered by nurses to all patients, 12 years and older, admitted to the general pediatric wards of a tertiary Children's Hospital. Nursing feedback and comfort levels were assessed before and after the 6-week pilot program. FINDINGS: During the 6 weeks, 152 eligible children were admitted to the general pediatric wards and 67 were screened using the ASQ; 3/67 had a nonacute "positive" screen and received a further psychiatric assessment. CONCLUSIONS: This pilot quality improvement initiative showed that suicide screening is feasible and acceptable to patients and families in a general pediatric inpatient setting. However, nurses would benefit from further teaching and training around asking suicide screening questions.