Understanding Caregiver Perspective on Social Determinants of Health Interventions in Pediatric Primary Care.

Comprehensive social risk screening has become standard practice in primary care. Evidence is lacking, however, on whether and how interventions provided for positive screens are being utilized. This study aimed to create a standardized follow-up process to evaluate caregiver perspective and usage of community resources provided during well-child visits. Follow-up calls were made to families with positive screens for food insecurity (FI) and/or utility insecurity (UI) (n = 347). Phone interviews assessed resource usage, effectiveness, influence on stress level, and current insecurity status. Caregiver responses regarding barriers to resource usage were inductively analyzed and developed into major themes. The sample included 228 (65.7%) families with positive screens for FI and 166 (47.8%) families screening positive for UI. Of those who completed interviews (n = 108), 77 (71.3%) caregivers recalled being provided resources during their child's visit with only 33 (42.9%) reporting use of those resources. Twelve (36.4%) of those caregivers who used the resources confirmed that their insecurity was still a concern. Five major themes for barriers to resource usage emerged: (1) improved situation, (2) perception, (3) access barriers, (4) conflicting priorities, and (5) too busy/overwhelmed. The majority of caregivers (95.7% of asked) noted that their insecurity caused increased stress with 70.5% acknowledging decreased stress levels after discussion with a provider. Integrating caregiver input through a standardized follow-up protocol into provided interventions for screened social risks can improve not only the quality and effectiveness of provided resources, but also provide insight into the impact of those interventions on insecurity from the caregiver perspective.

Longitudinal Narrative Analysis of Parent Experiences During Graded Exposure Treatment for Children With Chronic Pain.

OBJECTIVES: Parents have a vital influence over their child's chronic pain treatment and management. Graded exposure in vivo treatment (GET) is emerging as a promising intervention for youth with chronic pain. Yet, little is known about how parents perceive GET and its impact on their child's pain condition. This study aimed to characterize caregivers' experiences over the course of their child's GET using longitudinal coding and thematic analysis of parent narratives. MATERIALS AND METHODS: Parent narratives of 15 youth who participated in GET for pediatric chronic pain (GET Living) were elicited from an unstructured dialogue at the start of each treatment session held between the parent(s) and pain psychologist. Narratives were coded for affect and content, and trends were examined in these codes across sessions. Common themes in parent narratives were developed through inductive thematic analysis. RESULTS: Parents showed an increase in positive affect, treatment confidence, and optimism over the course of treatment. Narratives also expressed more benefit-finding/growth and less anxiety and protectiveness across GET sessions, with more parents having a resolved orientation towards their child's pain by the final session. Five common themes were generated: Self-Awareness, Understanding of Their Child's Perspective, Perceived Treatment Benefit, Internalization of Treatment Principles, and Hopeful Concern for the Future. DISCUSSION: Analysis of parent narratives provides a rich and unique method for understanding a parent's journey during their child's chronic pain treatment. Clinical application of our findings can be used to guide future developments of targeted topics and interventions in the context of parenting a child with chronic pain.

Avoid or engage? Outcomes of graded exposure in youth with chronic pain using a sequential replicated single-case randomized design.

Pain-related fear is typically associated with avoidance behavior and pain-related disability in youth with chronic pain. Youth with elevated pain-related fear have attenuated treatment responses; thus, targeted treatment is highly warranted. Evidence supporting graded in vivo exposure treatment (GET) for adults with chronic pain is considerable, but just emerging for youth. The current investigation represents the first sequential replicated and randomized single-case experimental phase design with multiple measures evaluating GET for youth with chronic pain, entitled GET Living. A cohort of 27 youth (81% female) with mixed chronic pain completed GET Living. For each participant, a no-treatment randomized baseline period was compared with GET Living and 3- and 6-month follow-ups. Daily changes in primary outcomes fear and avoidance and secondary outcomes pain catastrophizing, pain intensity, and pain acceptance were assessed using electronic diaries and subjected to descriptive and model-based inference analyses. Based on individual effect size calculations, a third of participants significantly improved by the end of treatment on fear, avoidance, and pain acceptance. By follow-up, over 80% of participants had improved across all primary and secondary outcomes. Model-based inference analysis results to examine the series of replicated cases were generally consistent. Improvements during GET Living was superior to the no-treatment randomized baseline period for avoidance, pain acceptance, and pain intensity, whereas fear and pain catastrophizing did not improve. All 5 outcomes emerged as significantly improved at 3- and 6-month follow-ups. The results of this replicated single-case experimental phase design support the effectiveness of graded exposure for youth with chronic pain and elevated pain-related fear avoidance.

Interaction of petroleum-relevant organosulfur compounds with TiO2(110).

The interaction of two sets of structurally related molecules, thiophenol/thioanisole, and thiophene/tetrahydrothiophene, with vacuum-annealed and ion-bombarded TiO(2)(110) surfaces has been studied using a combination of temperature-programmed reaction spectroscopy (TPRS) and X-ray photoelectron spectroscopy (XPS). All thioethers studied were observed to adsorb and desorb from both surfaces without producing reaction products, while thiophenol, the only species studied containing a S-H bond, reacted with both surfaces. Approximately 25% of surface bound thiophenol decomposed over the vacuum-annealed surface. On the bombarded surface, thiophenol both decomposed into surface-bound C(x)H(y)/S fragments, and reacted to form benzene, which desorbed from the surface at 400 K. We propose that phenylthiolate formation on the bombarded surface leads to the observed production of benzene. These results highlight the importance of defects in the reactivity of titania, and lay the foundation for the study of larger, refractory sulfur compounds present in fuel.