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1.
Adv Neonatal Care ; 24(3): 243-252, 2024 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-38729653

RESUMEN

BACKGROUND: Rising admission rates of Hispanic/Latinx families to the neonatal intensive care unit (NICU) have increased the number of non-English-speaking individuals who may wish to participate in research studies. However, a lack of appropriately translated research study materials may limit the opportunity for these families to be involved in research that could impact the care that infants and families receive in the NICU. PURPOSE: The primary purpose was to pilot test study materials that were transcreated from English to Spanish with the assistance of a bilingual community advisory board with Spanish-speaking parents of NICU infants. METHODS: A total of 19 Spanish-speaking parents (15 mothers and 4 fathers) who were representative of the population of interest completed paper-and-pencil surveys, along with a cognitive interview. Preliminary data related to decision-making and goals of care, infant symptoms, and their experiences in the NICU were also collected. RESULTS: The internal reliability of the transcreated study instruments ranged from good to excellent (α= 0.82-0.99). Participants reported that study materials were not offensive and did not make them feel uncomfortable; however, they found some words/phrases to be confusing. Parents had the opportunity to provide suggested wording changes. IMPLICATIONS FOR PRACTICE AND RESEARCH: Language barriers and a lack of cultural responsiveness can affect the care that infants and their families receive. More accurate and culturally appropriate transcreation of study materials can remove barriers to research participation and facilitate better communication with non-English-speaking families, which may lead to the development of better-informed evidence-based interventions and clinical practices in the NICU.


Asunto(s)
Hispánicos o Latinos , Unidades de Cuidado Intensivo Neonatal , Padres , Humanos , Proyectos Piloto , Recién Nacido , Femenino , Padres/psicología , Masculino , Hispánicos o Latinos/psicología , Adulto , Encuestas y Cuestionarios , Reproducibilidad de los Resultados , Barreras de Comunicación , Lenguaje , Traducción
2.
Sch Psychol ; 2024 Feb 08.
Artículo en Inglés | MEDLINE | ID: mdl-38330318

RESUMEN

Limited research has considered how family and school factors combine to support Latinx students' academic achievement in early adolescence. We examined associations between parental academic socialization (PAS), teacher support (TS), school belonging, and achievement outcomes to understand the roles of family and teacher factors in youths' school belonging and achievement. Youth (N = 65, mean age = 11.74, SD = 1.11) and their parents completed questionnaires on school belonging, PAS, and TS, and we collected grade point average, standardized test results, and teacher perceptions of student skills and traits from their schools. Results indicated that TS, but not PAS, was negatively associated with school belonging and achievement. Belonging mediated the effect of TS on academic outcomes through a positive indirect relation. Findings implicate the role of school psychologists in guiding teacher support strategies for Latinx students. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

3.
JCI Insight ; 8(16)2023 08 22.
Artículo en Inglés | MEDLINE | ID: mdl-37606047

RESUMEN

We investigated the extent, biologic characterization, phenotypic specificity, and possible regulation of a ß1-adrenergic receptor-linked (ß1-AR-linked) gene signaling network (ß1-GSN) involved in left ventricular (LV) eccentric pathologic remodeling. A 430-member ß1-GSN was identified by mRNA expression in transgenic mice overexpressing human ß1-ARs or from literature curation, which exhibited opposite directional behavior in interventricular septum endomyocardial biopsies taken from patients with beta-blocker-treated, reverse remodeled dilated cardiomyopathies. With reverse remodeling, the major biologic categories and percentage of the dominant directional change were as follows: metabolic (19.3%, 81% upregulated); gene regulation (14.9%, 78% upregulated); extracellular matrix/fibrosis (9.1%, 92% downregulated); and cell homeostasis (13.3%, 60% upregulated). Regarding the comparison of ß1-GSN categories with expression from 19,243 nonnetwork genes, phenotypic selection for major ß1-GSN categories was exhibited for LV end systolic volume (contractility measure), ejection fraction (remodeling index), and pulmonary wedge pressure (wall tension surrogate), beginning at 3 months and persisting to study completion at 12 months. In addition, 121 lncRNAs were identified as possibly involved in cis-acting regulation of ß1-GSN members. We conclude that an extensive 430-member gene network downstream from the ß1-AR is involved in pathologic ventricular remodeling, with metabolic genes as the most prevalent category.


Asunto(s)
Productos Biológicos , Cardiomiopatía Dilatada , Animales , Ratones , Humanos , Cardiomiopatía Dilatada/genética , Redes Reguladoras de Genes , Transducción de Señal , Ratones Transgénicos , Receptores Adrenérgicos
4.
Lang Speech Hear Serv Sch ; 54(4): 1233-1248, 2023 10 02.
Artículo en Inglés | MEDLINE | ID: mdl-37607387

RESUMEN

PURPOSE: Narratives have been a useful tool for evaluating language skills in young bilingual children. This study extends that work to bilingual adolescents by (a) describing their narrative skills and (b) evaluating the role of current language experience on measures of narrative micro- and macrostructure across Spanish and English. METHOD: Sixty-five Spanish-English bilingual adolescents, ages 10-15 years, were administered the Test of Narrative Language (TNL) in English and Spanish. Language samples were transcribed and coded for elements of narrative microstructure. Parents provided information about participants' current language experience. RESULTS: Means and standard deviations were reported for microstructure composites, TNL comprehension subtests, and TNL production subtests in Spanish and English. Findings showed differential effects of current English experience on narrative performance across Spanish and English, such that experience significantly explained 12%, 10%, and 20% of the variance in participants' microstructure scores, narrative comprehension, and narrative production in Spanish, respectively. Language experience was unrelated to performance across all English narrative measures. CONCLUSIONS: Findings suggest that continued use of Spanish may be important for bilinguals' maintenance of the home language during adolescence, particularly on narrative tasks that require bilinguals to produce Spanish. However, experience is insufficient to explain the variability in bilinguals' narrative skills across Spanish and English.


Asunto(s)
Multilingüismo , Niño , Humanos , Adolescente , Lenguaje , Lenguaje Infantil , Narración , Cognición
5.
Adv Neonatal Care ; 23(3): 212-219, 2023 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-36912673

RESUMEN

BACKGROUND: Admission rates of Hispanic/Latinx families to the neonatal intensive care unit (NICU) are rising, yet knowledge regarding their experiences is limited. Non-English-speaking families are often excluded from research because study measures are not available in their language. The inclusion of these families in NICU research is crucial to understand the impact of cultural and language barriers in infant and family care, and the translation of study measures into Spanish could better ensure that these families' perspectives are included. However, previous research has utilized the standard translation-backtranslation method with which problems have been noted. PURPOSE: This article describes the planning, preparation, and action phases that were completed with the use of a community advisory board (CAB) to prepare and transcreate research study materials from English to Spanish for pilot testing. METHODS: Community members of interest were invited to form the CAB, and 2 meetings were held to review study materials in the English and Spanish versions. Prior to the second meeting, a professional translation company translated study materials from English to Spanish. RESULTS: Feedback from the CAB ensured consistent content and reading levels, and culturally appropriate language usage. The CAB also provided suggestions to the research protocol and advised sensitive methods of recruitment and measure administration. IMPLICATIONS FOR PRACTICE AND RESEARCH: More accurate and culturally appropriate transcreation of study measures can reduce barriers to research participation and facilitate better communication with non-English-speaking families in health equity research to better inform evidence-based interventions and clinical practices across diverse groups.


Asunto(s)
Unidades de Cuidado Intensivo Neonatal , Lenguaje , Recién Nacido , Lactante , Humanos , Comunicación , Barreras de Comunicación
6.
J Pediatr Psychol ; 48(3): 193-201, 2023 03 20.
Artículo en Inglés | MEDLINE | ID: mdl-36644926

RESUMEN

OBJECTIVE: Parents of children with cancer are at risk for depressive symptoms, and previous research has linked their level of distress to various demographic, social, and economic factors. However, little research has examined associations between parental depressive symptoms and multiple socioecological factors at once. The current study examined how socioeconomic status (SES) at the individual and neighborhood level is related to parental depressive symptoms and social support satisfaction in Latinx and non-Latinx parents of children recently diagnosed with cancer, and whether social support satisfaction mediated associations between SES and depressive symptoms. METHODS: Parents (N = 115; 82% female; 30% Latinx) completed questionnaires reporting their demographic information, social support satisfaction, and depressive symptoms. Neighborhood SES was coded by block group level based on participants' home addresses. RESULTS: Individual, but not neighborhood, SES was positively associated with social support satisfaction, and higher social support satisfaction was associated with lower depressive symptoms. There was a significant indirect effect of individual (but not neighborhood) SES on depressive symptoms through social support satisfaction. Latinx parents reported lower individual SES, but not lower social support satisfaction or depressive symptoms than non-Latinx parents. CONCLUSIONS: These results highlight the important role of social support in the adjustment of parents who have a child with pediatric cancer. Findings suggest that families may benefit from services that target multiple levels of their social ecology.


Asunto(s)
Depresión , Neoplasias , Niño , Humanos , Femenino , Masculino , Padres , Clase Social , Apoyo Social , Factores Socioeconómicos
7.
Clin Pract Pediatr Psychol ; 10(2): 115-127, 2022 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-35694182

RESUMEN

Objective: Psychosocial stress contributes to asthma disparities for low-SES Latinx children, but primary and secondary control coping by children and parents is associated with better psychosocial and asthma outcomes. Therefore, we developed and pilot tested Adapt 2 Asthma (A2A), a family-based coping and asthma self-management intervention for low-SES Latinx families. Methods: Children, parents, and primary care providers (N=16) participated in five focus groups to refine A2A's content and delivery. Subsequently, families of children ages 9-12 with asthma (N=24) were recruited from primary care clinics and randomly assigned to receive A2A or enhanced usual care (EUC). Results: Based on focus groups, A2A was refined to address feasibility, Latinx-specific cultural factors, and provider-family gaps. Results of the pilot RCT showed that 92% of families completed all sessions of A2A, and there were high levels of satisfaction with and fidelity to A2A. There were no statistically significant differences between the A2A and EUC groups at 3-month follow-up, although there were small, non-significant effects favoring A2A on parent-reported asthma control, parent secondary control coping, and emergency department visits. Conclusions: We found evidence of acceptability, feasibility, and potential benefits of A2A for low-SES Latinx families. Findings provide guidance for future implementation in primary care.

8.
J Allergy Clin Immunol Pract ; 10(4): 1005-1012.e1, 2022 04.
Artículo en Inglés | MEDLINE | ID: mdl-34626856

RESUMEN

BACKGROUND: Neighborhood and caregiver characteristics have each been linked to children's asthma outcomes, but less is known about how caregiver psychosocial functioning may explain the link between neighborhood characteristics and asthma outcomes. OBJECTIVE: To examine associations between neighborhood safety, caregiver stress and depressive symptoms, and children's asthma outcomes, and to evaluate whether caregiver stress and depressive symptoms mediate the relationship between neighborhood safety and asthma outcomes. METHODS: We analyzed baseline data from a prospective cohort study of the effects of a housing mobility program on children's asthma-related outcomes. Age- and sex-adjusted models evaluated associations of neighborhood safety, and caregiver stress and depressive symptoms, with children's asthma symptoms and exacerbations. RESULTS: Participants were 140 low-income children with persistent asthma (98% Black participants; 53% males; mean age, 9.0 years) with an average of 7.1 ± 5.3 maximum symptom days per 2 weeks. Lower neighborhood safety, and higher caregiver stress and depressive symptoms, were associated with higher asthma symptoms, but not exacerbations, in adjusted models (eg, for neighborhood safety, maximum symptom days: odds ratio, 1.41; 95% CI, 1.07-1.88; for caregiver stress, maximum symptom days: odds ratio, 1.08; 95% CI, 1.01-1.15; for depressive symptoms, maximum symptom days: odds ratio, 1.05; 95% CI, 1.00-1.11). Exploratory analyses suggested that caregiver stress partially mediated associations between neighborhood safety and asthma symptoms for children in unsafe neighborhoods. CONCLUSIONS: Neighborhood safety was associated with children's asthma symptoms independent from caregiver stress and depressive symptoms, although for children in unsafe neighborhoods, caregiver stress may partially mediate this association. Findings suggest the importance of targeting multiple systems to improve children's asthma outcomes.


Asunto(s)
Asma , Cuidadores , Asma/diagnóstico , Niño , Femenino , Humanos , Masculino , Pobreza , Estudios Prospectivos , Características de la Residencia
9.
J Pediatr Psychol ; 46(8): 960-969, 2021 08 19.
Artículo en Inglés | MEDLINE | ID: mdl-33738496

RESUMEN

OBJECTIVE: To identify coping trajectories from diagnosis through survivorship and test whether particular trajectories exhibit better health-related quality of life (HRQOL) at 5 years post-diagnosis. METHODS: Families of children with cancer (ages 5-17; M = 10.48, SD = 4.03) were recruited following a new diagnosis of cancer (N = 248). Three follow-up assessments occurred at 1-year (N = 185), 3-years (N = 101), and 5-years (N = 110). Mothers reported on children's coping using the Responses to Stress Questionnaire for Pediatric Cancer. Survivor HRQOL was measured at 5-year follow-up using self-report on the PedsQL 4.0. Longitudinal patterns of coping were derived using Latent Class Growth Analysis and mean-levels of survivor-report HRQOL were compared across classes. RESULTS: Two primary control coping trajectories emerged, "Moderate and Stable" (50%) and "Low-moderate and Decreasing" (50%), with no significant differences in HRQOL across trajectories. Three secondary control coping trajectories emerged, "Moderate-high and Increasing" (54%), "Moderate and Stable" (40%), and "High and Increasing" (6%), with survivors in the last trajectory showing better HRQOL. Two disengagement coping trajectories emerged, "Low and Stable" (85%) and "Low and Variable" (15%), with no significant differences in HRQOL across trajectories. CONCLUSIONS: Coping trajectories were relatively stable from diagnosis to 5 years. A small group of survivors with high and increasing secondary control coping over time, per mother-report, reported better HRQOL. Future research should consider tailoring coping interventions to children with cancer to improve survivors' HRQOL.


Asunto(s)
Supervivientes de Cáncer , Neoplasias , Adaptación Psicológica , Adolescente , Niño , Preescolar , Femenino , Humanos , Calidad de Vida , Sobrevivientes
10.
Pediatr Blood Cancer ; 68(3): e28826, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33320998

RESUMEN

OBJECTIVE: Despite calls to increase prognosis communication for adolescents with cancer, limited research has examined their perceptions of prognosis as compared with their parents. We assessed adolescents' understanding of their prognosis relative to parents and oncologists. METHODS: Families of adolescents (aged 10-17) were recruited at two pediatric institutions following a new diagnosis or relapse. Seventy-four adolescents, 68 mothers, and 40 fathers participated at enrollment; 76 adolescents, 69 mothers, and 35 fathers participated one year later. The adolescent's primary oncologist reported on prognosis only at enrollment. Participants rated the likelihood of the adolescent's survival in five years, as well as reporting prognosis communication and sources of information. RESULTS: Most oncologists (65%) and fathers (63%) discussed prognosis in numerical terms with the adolescent at baseline, which was greater than mother report (49%) of discussions of numerical prognosis with adolescents. Adolescents reported a better prognosis than oncologists, but comparable with mothers at diagnosis and one year. Adolescents' prognosis estimates were stable over time (P > .05). At diagnosis, adolescent-father (P = 0.025) and adolescent-oncologist (P < 0.001) discrepancies were larger for youth with advanced than non-advanced cancer. Adolescents whose parents received numerical prognosis estimates from the oncologist, and whose fathers reported providing numerical prognosis estimates had more accurate understandings of prognosis (P < 0.05). CONCLUSIONS: Adolescent prognosis estimates were comparable with those of parents at diagnosis and one year but more favorable than that of oncologists. Although additional research is needed, results suggest discrepancies in prognosis estimates between family members and oncologists, particularly for adolescents with advanced cancer.


Asunto(s)
Comunicación , Neoplasias/patología , Neoplasias/psicología , Oncólogos/psicología , Padres/psicología , Adolescente , Niño , Femenino , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Masculino , Neoplasias/terapia , Pronóstico , Encuestas y Cuestionarios
11.
J Psychosoc Oncol ; 39(5): 613-628, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-32942948

RESUMEN

PURPOSE: Pediatric cancer may impact parents' partner relationship and increase patient, parent, and sibling distress. This study examined parents' reports of their relationship adjustment and depressive symptoms and their association with their ratings of patients' and siblings' emotional/behavioral problems in families of recently diagnosed pediatric cancer patients. DESIGN: Cross-sectional questionnaire study. SAMPLE: A total of 31 parents (87% female; 71% Latino) of pediatric cancer patients. METHODS: Parents reported on their relationship adjustment, depressive symptoms, and the patients' and siblings' emotional/behavioral problems. FINDINGS: Poorer relationship adjustment was correlated with more parent depressive symptoms and patient emotional/behavioral problems. Parent depressive symptoms were positively correlated with emotional/behavioral problems in patients and siblings. After accounting for child age and parent depressive symptoms, relationship adjustment remained significantly associated with patient, but not sibling, problems. CONCLUSIONS: When parents have poorer relationship adjustment following diagnosis, children with cancer may be at increased risk for emotional/behavioral problems. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS OR POLICY: Interventions targeting the partner relationship may be relevant to supporting family adjustment following diagnosis.


Asunto(s)
Neoplasias , Hermanos , Niño , Estudios Transversales , Depresión , Femenino , Humanos , Masculino , Padres
12.
Psychooncology ; 30(4): 536-545, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33227159

RESUMEN

OBJECTIVE: Providing opportunities to communicate about possible cancer recurrence may be adaptive for youth in remission, yet parents may experience difficulty guiding discussions related to fears of cancer recurrence (FCR). This study aimed to characterize mother-child discussions about potential cancer recurrence during post-treatment survivorship and to determine predictors of maternal communication. METHODS: Families (N = 67) were recruited after the child's initial cancer diagnosis (age 5-17 years) and mothers self-reported their distress (post-traumatic stress symptoms; PTSS). During survivorship 3-5 years later, mothers were video-recorded discussing cancer with their children. Presence and length of discussion about potential cancer recurrence, triggers for FCR, expressed affect, and conversational reciprocity were examined. Hierarchical regressions were used to assess maternal PTSS near the time of cancer diagnosis and child age as predictors of maternal communication. RESULTS: Three-quarters of dyads spontaneously discussed risk for or fears about cancer recurrence; mothers initiated the topic more frequently than their children. Dyads discussed internal (bodily symptoms) and external (medical, social) triggers of FCR. Higher maternal PTSS at diagnosis predicted significantly lower levels of maternal positive affect (ß = -0.36, p = 0.02) and higher levels of maternal negative affect (ß = 0.30, p = 0.04) during discussion of recurrence 3-5 years later. Older child age significantly predicted higher levels of maternal negative affect (ß = 0.35, p = 0.02). Higher maternal PTSS at diagnosis predicted shorter discussions about recurrence for younger children (ß = 0.27, p = 0.02). CONCLUSIONS: Understanding predictors and characteristics of mother-child discussions about recurrence can guide family-based FCR interventions, particularly those promoting communication as a supportive tool. Both maternal PTSS and child age are important to consider when developing these interventions.


Asunto(s)
Neoplasias , Trastornos por Estrés Postraumático , Adolescente , Niño , Preescolar , Comunicación , Femenino , Humanos , Relaciones Madre-Hijo , Madres , Supervivencia
13.
JACC Basic Transl Sci ; 5(9): 871-883, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32838074

RESUMEN

Using serial analysis of myocardial gene expression employing endomyocardial biopsy starting material in a dilated cardiomyopathy cohort, we show that mRNA expression of the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) cardiac myocyte receptor ACE2 is up-regulated with remodeling and with reverse remodeling down-regulates into the normal range. The proteases responsible for virus-cell membrane fusion were expressed but not regulated with remodeling. In addition, a new candidate for SARS-CoV-2 cell binding and entry was identified, the integrin encoded by ITGA5. Up-regulation in ACE2 in remodeled left ventricles may explain worse outcomes in patients with coronavirus disease 2019 who have underlying myocardial disorders, and counteracting ACE2 up-regulation is a possible therapeutic approach to minimizing cardiac damage.

14.
Dev Psychol ; 56(8): 1582-1595, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32525330

RESUMEN

We advance a tripartite framework of language use to encompass language skills, the practice of language skills, and the subjective experiences associated with language use among Mexican-origin adolescents who function as language brokers by translating and interpreting for their English-limited parents. Using data collected over 2 waves from a sample of 604 adolescents (Wave 1: Mage = 12.41, SD = 0.97), this study identified 4 types of bilingual language broker profiles that capture the tripartite framework of language use: efficacious, moderate, ambivalent, and nonchalant. All 4 profiles emerged across waves and brokering recipients (i.e., mothers, fathers), except for Wave 1 brokering for mother, in which case only 3 profiles (i.e., efficacious, moderate, and ambivalent) emerged. Three profiles emerged across time: stable efficacious, stable moderate, and other. The efficacious and stable efficacious profiles showed the most consistent relation to adolescents' academic competence. Improving bilingual language proficiency, together with fostering more frequently positive brokering experiences, may be an avenue to improving academic competence among Mexican-origin adolescents in the United States. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Asunto(s)
Éxito Académico , Emigrantes e Inmigrantes/psicología , Multilingüismo , Relaciones Padres-Hijo , Padres , Traducción , Adolescente , Niño , Femenino , Humanos , Masculino , México/etnología , Padres/psicología
15.
Qual Health Res ; 30(4): 547-559, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31339447

RESUMEN

Despite risk for mental health difficulties, Latinx youth have among the lowest rates of mental health care utilization. With this study, we contribute to our ongoing community-based participatory research (CBPR) efforts to explore stressors and protective factors experienced by low-socioeconomic status (SES) Latinx youth, and how these factors influence mental health care utilization. We interviewed community providers and stakeholders (N = 11) from organizations serving low-SES Latinx youth. Coded data yielded seven categories of specific stressors, protective factors, and processes by which these factors influence service utilization. Across categories, providers emphasized how combined family and socioeconomic risk contributed to disengagement from services and described schools and community programs as buffering this risk. Findings suggest that the unique experiences of low-SES Latinx youth contribute to low rates of service utilization, and that intervention should address specific factors at the family, school, and community level to improve access to care.


Asunto(s)
Accesibilidad a los Servicios de Salud/organización & administración , Hispánicos o Latinos/psicología , Trastornos Mentales/terapia , Servicios de Salud Mental/organización & administración , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Adolescente , Femenino , Grupos Focales , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Masculino , Servicios de Salud Mental/estadística & datos numéricos , Investigación Cualitativa , Texas , Adulto Joven
17.
PLoS One ; 14(8): e0221519, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31469842

RESUMEN

OBJECTIVES: To investigate the biologic relevance of cross-platform concordant changes in gene expression in intact human failing/hypertrophied ventricular myocardium undergoing reverse remodeling. BACKGROUND: Information is lacking on genes and networks involved in remodeled human LVs, and in the associated investigative best practices. METHODS: We measured mRNA expression in ventricular septal endomyocardial biopsies from 47 idiopathic dilated cardiomyopathy patients, at baseline and after 3-12 months of ß-blocker treatment to effect left ventricular (LV) reverse remodeling as measured by ejection fraction (LVEF). Cross-platform gene expression change concordance was investigated in reverse remodeling Responders (R) and Nonresponders (NR) using 3 platforms (RT-qPCR, microarray, and RNA-Seq) and two cohorts (All 47 subjects (A-S) and a 12 patient "Super-Responder" (S-R) subset of A-S). RESULTS: For 50 prespecified candidate genes, in A-S mRNA expression 2 platform concordance (CcpT), but not single platform change, was directly related to reverse remodeling, indicating CcpT has biologic significance. Candidate genes yielded a CcpT (PCR/microarray) of 62% for Responder vs. Nonresponder (R/NR) change from baseline analysis in A-S, and ranged from 38% to 100% in S-R for PCR/microarray/RNA-Seq 2 platform comparisons. Global gene CcpT measured by microarray/RNA-Seq was less than for candidate genes, in S-R R/NR 17.5% vs. 38% (P = 0.036). For S-R global gene expression changes, both cross-cohort concordance (CccT) and CcpT yielded markedly greater values for an R/NR vs. an R-only analysis (by 22 fold for CccT and 7 fold for CcpT). Pathway analysis of concordant global changes for R/NR in S-R revealed signals for downregulation of multiple phosphoinositide canonical pathways, plus expected evidence of a ß1-adrenergic receptor gene network including enhanced Ca2+ signaling. CONCLUSIONS: Two-platform concordant change in candidate gene expression is associated with LV biologic effects, and global expression concordant changes are best identified in an R/NR design that can yield novel information.

18.
Community Ment Health J ; 55(4): 569-577, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30171449

RESUMEN

Integrated behavioral health services have positive outcomes for patients and providers, but little is known about providers' perspectives on implementing these services. This community-based participatory research collaboration with a Federally Qualified Health Center examined provider perspectives on implementing a collaborative psychiatry consultation program in pediatric primary care. We interviewed providers (N = 14) from psychiatry, social work, primary care, and psychology regarding their experiences implementing the program, and their recommendations for its sustainability. Providers described interdisciplinary integration arising from the program, with accompanying benefits (e.g., increased access to care for patients with complex diagnostic profiles, increased learning and role satisfaction among providers), and challenges (e.g., increased burden on primary care providers, potential patient discomfort with team-based care). Our results highlight the complexities of implementing collaborative psychiatry consultation in pediatric primary care, and suggest the importance of supporting primary care providers and patients within this context.


Asunto(s)
Investigación Participativa Basada en la Comunidad , Prestación Integrada de Atención de Salud/organización & administración , Comunicación Interdisciplinaria , Servicios de Salud Mental/organización & administración , Atención Primaria de Salud/organización & administración , Niño , Servicios de Salud del Niño/organización & administración , Humanos
19.
J Pediatr Psychol ; 43(10): 1114-1127, 2018 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-30016505

RESUMEN

Objective: This study aimed to characterize mothers' communication with their children in a sample of families with a new or newly relapsed pediatric cancer diagnosis, first using factor analysis and second using structural equation modeling to examine relations between self-reported maternal distress (anxiety, depression, and posttraumatic stress) and maternal communication in prospective analyses. A hierarchical model of communication was proposed, based on a theoretical framework of warmth and control. Methods: The sample included 115 children (age 5-17 years) with new or newly relapsed cancer (41% leukemia, 18% lymphoma, 6% brain tumor, and 35% other) and their mothers. Mothers reported distress (Beck Anxiety Inventory, Beck Depression Inventory-II, and Impact of Events Scale-Revised) 2 months after diagnosis (Time 1). Three months later (Time 2), mother-child dyads were video-recorded discussing cancer. Maternal communication was coded with the Iowa Family Interaction Ratings Scales. Results: Confirmatory factor analysis demonstrated poor fit. Exploratory factor analysis suggested a six-factor model (root mean square error of approximation = .04) with one factor reflecting Positive Communication, four factors reflecting Negative Communication (Hostile/Intrusive, Lecturing, Withdrawn, and Inconsistent), and one factor reflecting Expression of Negative Affect. Maternal distress symptoms at Time 1 were all significantly, negatively related to Positive Communication and differentially related to Negative Communication factors at Time 2. Maternal posttraumatic stress and depressive symptoms each predicted Expression of Negative Affect. Conclusions: Findings provide a nuanced understanding of maternal communication in pediatric cancer and identify prospective pathways of risk between maternal distress and communication that can be targeted in intervention.


Asunto(s)
Comunicación , Trastornos Mentales/psicología , Relaciones Madre-Hijo/psicología , Madres/psicología , Neoplasias/psicología , Adolescente , Adulto , Trastornos de Ansiedad/psicología , Niño , Preescolar , Trastorno Depresivo/psicología , Análisis Factorial , Femenino , Humanos , Masculino , Medio Oeste de Estados Unidos , Madres/estadística & datos numéricos , Estudios Prospectivos , Recurrencia , Trastornos por Estrés Postraumático/psicología
20.
Fam Syst Health ; 36(3): 327-337, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-29172629

RESUMEN

INTRODUCTION: Low-income, ethnic minority children disproportionately face poor asthma control, and poorly controlled asthma is related to psychosocial difficulties. This study assessed physician reports of coping in child patients and examined associations between physician reports of child coping and parent and child reports of children's coping, psychosocial, and asthma outcomes (asthma-related stress, emotional and behavioral problems, asthma control, and school missed due to asthma). METHOD: Physicians reported on coping in their patients (N = 67) ages 5-17 with asthma. Parents reported on child coping, asthma-related stress, emotional and behavioral problems, asthma control, and school missed due to asthma. Children ages 9-17 provided self-reports. RESULTS: Physicians' reports of primary control coping (e.g., problem solving) and secondary control coping (e.g., cognitive restructuring) were not associated with parent ratings of corresponding coping strategies, but physician reports of disengagement coping (e.g., avoidance) were correlated with parent reports of disengagement and secondary control coping. Physician perceptions of higher child primary control, and lower disengagement, were correlated with less parent-reported stress, better asthma control, and for primary control, fewer partial days of school missed. Physician reports were not correlated with child reports of coping, but physician reports of disengagement were correlated with child-reported conduct problems. DISCUSSION: Findings suggest that physician reports of child coping provide independent information from parent and child reports of coping, and could be leveraged to identify and intervene with patients who are at elevated risk for poor outcomes. (PsycINFO Database Record


Asunto(s)
Adaptación Psicológica , Asma/psicología , Niños con Discapacidad/psicología , Percepción , Médicos/psicología , Adolescente , Asma/complicaciones , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Masculino , Pediatría/métodos , Pediatría/normas , Estrés Psicológico/etiología , Estrés Psicológico/psicología
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