Search

Data on sleep behavior were gathered on 100 children with pervasive developmental disorders (PDD), ages 2-11 years, using sleep diaries, the Children's Sleep Habits Questionnaire (CSHQ), and the Parenting Events Questionnaire. Two time periods were sampled to assess short-term stability of sleep-wake patterns. Before data collection, slightly more than half of the parents, when queried, reported a sleep problem in their child. Subsequent diary and CSHQ reports confirmed more fragmented sleep in those children who were described by their parents as having a sleep problem compared to those without a designated problem. Interestingly, regardless of parental perception of problematic sleep, all children with PDD exhibited longer sleep onset times and greater fragmentation of sleep than that reported for age-matched community norms. The results demonstrate that sleep problems identified by the parent, as well as fragmentation of sleep patterns obtained from sleep diary and CSHQ data, exist in a significant proportion of children with PDD. [ABSTRACT FROM AUTHOR]

Background: The American Heart Association has identified poor mental health as a key barrier to healthy behavior change for those with cardiovascular disease (CVD) risk factors such as high blood pressure, high cholesterol, and diabetes. Digital mental health interventions, like those delivered via the internet to computers or smartphones, may provide a scalable solution to improving the mental and physical health of this population. Happify is one such intervention and has demonstrated evidence of efficacy for improving aspects of mental health in both the general population and in users with chronic conditions., Objective: The objectives of this analysis of real-world data from Happify users with self-reported CVD risk factors, including high blood pressure and cholesterol, diabetes, and heart disease, were to examine whether these users would report improvements in subjective well-being and anxiety over time (H1) and use of Happify as recommended would be associated with significantly greater improvement in subjective well-being and anxiety over time compared to less-than-recommended usage (H2)., Methods: Data were obtained from existing Happify users who reported the aforementioned CVD risk factors. The sample included 1803 users receiving at least 6 weeks' exposure to Happify (ranging from 42 days to 182 days) who completed at least one activity and two assessments within the app during that time. Subjective well-being was assessed with the Happify Scale, a 9-item measure of positive emotionality and life satisfaction, and anxiety was assessed with the Generalized Anxiety Disorder 2 (GAD-2). To evaluate H1, changes over time in both outcomes were assessed using mixed effects linear regression models, controlling for demographics and usage. For H2, an interaction term was added to the models to assess whether usage as recommended was associated with greater improvement over time., Results: Both hypotheses were supported. For both the Happify scale and GAD-2, the initial multivariable model without an interaction demonstrated an effect for time from baseline, and the addition of the interaction term between time and recommended use was significant as well., Conclusions: This analysis of real-world data provides preliminary evidence that Happify users with self-reported CVD risk factors including high blood pressure or cholesterol, diabetes, and heart disease experienced improved well-being and anxiety over time and that those who used Happify as recommended experienced greater improvements in these aspects of mental health than those who completed fewer activities. These findings extend previous research, which demonstrated that engagement with Happify as recommended was associated with improved well-being among physically healthy users and in those with chronic conditions, to a new population for whom mental health is especially critical: those at risk of developing CVD., (©Robert M Montgomery, Eliane M Boucher, Ryan D Honomichl, Tyler A Powell, Sharelle L Guyton, Samantha L Bernecker, Sarah Elizabeth Stoeckl, Acacia C Parks. Originally published in JMIR Cardio (https://cardio.jmir.org), 19.11.2021.)

Purpose: Item response theory (IRT) scoring provides T-scores for physical and mental health subscales on the Patient-Reported Outcomes Measurement Information System Global Health questionnaire (PROMIS-GH) even when relevant items are skipped. We compared different item- and score-level imputation methods for estimating T-scores to the current scoring method., Methods: Missing PROMIS-GH items were simulated using a dataset of complete PROMIS-GH scales collected at a single tertiary care center. Four methods were used to estimate T-scores with missing item scores: (1) IRT-based scoring of available items (IRT avail ), (2) item-level imputation using predictive mean matching (PMM), (3) item-level imputation using proportional odds logistic regression (POLR), and (4) T-score-level imputation (IMP direct ). Performance was assessed using root mean squared error (RMSE) and mean absolute error (MAE) of T-scores and comparing estimated regression coefficients from the four methods to the complete data model. Different proportions of missingness and sample sizes were examined., Results: IRT avail had lowest RMSE and MAE for mental health T-scores while PMM had lowest RMSE and MAE for physical health T-scores. For both physical and mental health T-scores, regression coefficients estimated from imputation methods were closer to those of the complete data model., Conclusions: The available item scoring method produced more accurate PROMIS-GH mental but less accurate physical T-scores, compared to imputation methods. Using item-level imputation strategies may result in regression coefficient estimates closer to those of the complete data model when nonresponse rate is high. The choice of method may depend on the application, sample size, and amount of missingness.

Background: Chronic conditions account for 75% of health care costs, and the impact of chronic illness is expected to grow over time. Although subjective well-being predicts better health outcomes, people with chronic conditions tend to report lower well-being. Improving well-being might mitigate costs associated with chronic illness; however, existing interventions can be difficult to access and draw from a single theoretical approach. Happify, a digital well-being intervention program drawing from multiple theoretical traditions to target well-being, has already been established as an efficacious means of improving well-being in both distressed and nondistressed users., Objective: This study aimed to compare change in well-being over time after using Happify for users with and without a chronic condition., Methods: Data were obtained from Happify users, a publicly available digital well-being program accessible via website or mobile phone app. Users work on tracks addressing a specific issue (eg, conquering negative thoughts) composed of games and activities based on positive psychology, cognitive behavioral therapy, and mindfulness principles. The sample included 821 users receiving at least 6 weeks' exposure to Happify (ranging from 42 to 179 days) who met other inclusion criteria. As part of a baseline questionnaire, respondents reported demographic information (age and gender) and whether they had any of the prespecified chronic conditions: arthritis, diabetes, insomnia, multiple sclerosis, chronic pain, psoriasis, eczema, or some other condition (450 reported a chronic condition, whereas 371 did not). Subjective well-being was assessed with the Happify Scale, a 9-item measure of positive emotionality and life satisfaction. To evaluate changes in well-being over time, a mixed effects linear regression model was fit for subjective well-being, controlling for demographics and platform usage., Results: At baseline, users with a chronic condition had significantly lower subjective well-being (mean 38.34, SD 17.40) than users without a chronic condition (mean 43.65, SD 19.13). However, change trajectories for users with or without a chronic condition were not significantly different; both groups experienced equivalent improvements in well-being. We also found an effect for time from baseline (b=0.071; SE=0.010; P<.01) and number of activities completed (b=0.03; SE=0.009; P<.01), and a 2-way interaction between number of activities completed and time from baseline (b=0.0002; SE=0.00006; P<.01), such that completing more activities and doing so over increasingly longer periods produced improved well-being scores., Conclusions: Data from this study support the conclusion that users with a chronic condition experienced significant improvement over time. Despite reporting lower subjective well-being on the whole, their change trajectory while using Happify was equivalent to those without a chronic condition. Consistent with past research, users who completed more activities over a longer period showed the most improvement. In short, the presence of a chronic condition did not prevent users from showing improved well-being when using Happify., (©Acacia C Parks, Allison L Williams, Gina M Kackloudis, Julia L Stafford, Eliane M Boucher, Ryan D Honomichl. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 10.01.2020.)

Objective: The Cognition Battery of the National Institutes of Heath Toolbox is a commonly utilized set of assessments of neuropsychological abilities, evaluating executive function, attention, working memory, processing speed, and episodic memory. We highlight the utility of an advanced statistical model in providing nuanced characterization of neurocognition in an adolescent population. We propose that partially ordered set (POSET) models are well suited to analyze polyfactorial tasks and identify distinct profiles of cognitive functioning., Method: Two models were considered using POSET classification. The first modeled 5 distinct cognitive functions and allowed for multiple functions to contribute to task performance. The second simpler model involved only 2 broader-based functions without polyfactorial task specifications. Existing performance data from 745 adolescents aged 14-17 years were analyzed. Posterior probabilities of classification performance and the discriminatory properties of the estimated response distributions indicated how well the modeling approaches fit the data., Results: The larger first model resulted in 8 profiles or states characterized by combinations of high or low functioning in 5 distinct functions. The simpler second model involved 2 broader-based functions that resulted in 4 states. Comparing model fit criteria, we believe that the finer-grained first model may better reflect the cognitive constructs associated with the tasks. Notably, POSET modeling did not always provide adequate classification of working memory because of the limited design of the Cognition Battery., Conclusions: We demonstrate that the use of POSET models is a feasible approach for detailed analysis of neurocognitive data that can extract information on cognitive functions, even when provided with limited task batteries. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Background: There has been increasing focus on both patient-reported outcome measurement (PROM) collection and patient satisfaction ratings; nevertheless, little is known about their relationship., Objectives: To determine the association between patient experience with PROM collection and visit satisfaction and to identify characteristics of better ratings for each., Methods: This cross-sectional observational study included all patients seen in 15 neurological clinics who completed PROMs as well as 6 questions on the patient experience with PROMs at least once from October 1, 2015 to December 31, 2016. Visit satisfaction was evaluated using a composite measure of physician communication, overall physician rating, and the likelihood of recommending that physician as indicated on the Clinician and Group Consumer Assessment of Healthcare Providers and Systems survey. Predictors of PROM experience and satisfaction were identified using proportional odds and logistic regression models, respectively., Results: There were 6454 patients (average age 58 ± 15 years, 59% women) who completed PROMs and responded to the Clinician and Group Consumer Assessment of Healthcare Providers and Systems survey. There were significant positive associations between each PROM experience question and visit satisfaction (r = 0.11-0.19; P<.010), although factors predicting visit satisfaction differed from those predicting PROM experience. A differential effect of PROMs on visit satisfaction was identified for patients who were nonwhite, had lower income, and had more comorbidities., Conclusions: Although there was a significant association between better PROM experience and higher visit satisfaction, relationships with clinical characteristics differed, providing insights into how PROMs may be associated with patients' visit satisfaction. Further research is necessary to confirm whether PROMs can be used to improve visit satisfaction, particularly in patients who historically have reported lower quality of care., (Copyright © 2019 ISPOR–The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)

Objective: Extremely premature infants are at risk for childhood wheezing. Early respiratory support and intermittent hypoxemia (IH) events may be associated with adverse breathing outcomes., Study Design: A single-center retrospective cohort study of 137 premature infants <28 weeks gestational age characterized the associations of cumulative oxygen, cumulative mean airway pressure, IH, and oxygen saturation (SpO 2 ) on the primary outcome of prescription asthma medication use at 2-year follow-up. Relative risk was calculated by generalized estimating equations., Results: Reported asthma medication use was 46%. At 1-3 days of age, elevated cumulative oxygen exposure, increased daily IH, and lower mean SpO 2 (adjusted for gestational age and sex) and increased cumulative mean airway pressure exposure (unadjusted) were associated with asthma medication use., Conclusion: Increased oxygen and frequent IH events during just the first 3 days of age may help identify extremely premature newborns at risk for symptomatic childhood wheezing requiring prescription asthma medications.

Discovery learning is an important, yet controversial topic in the fields of psychology, education, and cognitive science. Though traditional views emphasize a lack of instructional constraint or scaffolding, more recent evidence suggests that guidance should be included in the process of discovery learning. The present review summarizes three general approaches which have been shown to facilitate guided discovery learning: (1) strategic presentation of materials, (2) consequential feedback, and (3) probing questions and self-explanations. Techniques for implementing approaches are discussed, as well as the underlying mechanisms that contribute to their effectiveness. WIREs Cogn Sci 2012. doi: 10.1002/wcs.1199 For further resources related to this article, please visit the WIREs website., (Copyright © 2012 John Wiley & Sons, Ltd.)

Objectives: We sought to assess the attitudes of pediatric intensive care unit medical directors in California regarding the need for, the validity of, and the potential impact of benchmarking, public reporting, and pay-for-performance on pediatric critical care., Design: Cross-sectional survey., Setting: Pediatric intensive care units in California., Subjects: Medical directors of pediatric intensive care units., Interventions: None., Measurements and Main Results: Self-administered questionnaire and a semi-structured phone interview from 16 pediatric intensive care unit medical directors. All data were anonymized before review. Standard methods for identifying and agreeing on themes in transcribed interviews were applied. Seventy-three percent of California pediatric intensive care unit medical directors agree that benchmarking improves patient outcomes but are undecided whether public reporting and pay-for-performance improve healthcare quality. They are wary of the validity of data used to generate these performance measures and are discouraged by the time and costs required to collect data for standard performance outcomes (severity-adjusted pediatric intensive care unit mortality). Leadership opinions appear potentially "dynamic" in multiple domains and across each of the measures assessed., Conclusions: Pediatric intensive care unit medical directors sometimes express contradictory opinions about the merits of shared benchmarking efforts and express concerns across a range of logistic, methodological, and policy issues. These findings raise fundamental questions about how to create clinical performance standards that facilitate quality improvement in the face of a seriously divided constituency. Further, we propose that pediatric intensive care unit medical directors play more active roles in the development, implementation, and communication of shared state-wide data collection.

Preschoolers are typically unable to switch sorting rules during the Dimensional Change Card Sort task. One explanation for this phenomenon is attentional inflexibility (Kirkham, Cruess, & Diamond, 2003). In 4 experiments with 3- to 4-year-olds, we tested this hypothesis by examining the influence of dimensional salience on switching performance. Results from these experiments demonstrated that it was more difficult for children to redirect attention from attribute-based rule sets, such as color and shape, than from spatial relational rule sets. Overall, these findings point to a role for attention in performance on the Dimensional Change Card Sort task.

Relational reasoning is an essential component of fluid intelligence, and is known to have a protracted developmental trajectory. To date, little is known about the neural changes that underlie improvements in reasoning ability over development. In this event-related functional magnetic resonance imaging (fMRI) study, children aged 8-12 and adults aged 18-25 performed a relational reasoning task adapted from Raven's Progressive Matrices. The task included three levels of relational reasoning demands: REL-0, REL-1, and REL-2. Children exhibited disproportionately lower accuracy than adults on trials that required integration of two relations (REL-2). Like adults, children engaged lateral prefrontal cortex (PFC) and parietal cortex during task performance; however, they exhibited different time courses and activation profiles, providing insight into their approach to the problems. As in prior studies, adults exhibited increased rostrolateral PFC (RLPFC) activation when relational integration was required (REL-2 > REL-1, REL-0). Children also engaged RLPFC most strongly for REL-2 problems at early stages of processing, but this differential activation relative to REL-1 trials was not sustained throughout the trial. These results suggest that the children recruited RLPFC while processing relations, but failed to use it to integrate across two relations. Relational integration is critical for solving a variety of problems, and for appreciating analogies; the current findings suggest that developmental improvements in this function rely on changes in the profile of engagement of RLPFC, as well as dorsolateral PFC and parietal cortex.

The objectives of this pilot study were 1) to examine possible effects of secretin infusions on sleep-wake state organization in children with autism, and 2) to assess the feasibility of home recordings using time-lapse videosomnography in children with autism. Participants were a subset of subjects from two double blind, placebo-control, multi-center clinical trials. One trial, the UC Irvine study, assessed the effects of porcine secretin vs. saline infusions on children's behavior, language and IQ. The UC Davis trial assessed the effects of synthetic human secretin vs. saline infusions on behavior, language and gastrointestinal function. The sleep study enrolled some of the children from each of the two trials to observe possible secretin effects on sleep. To examine sleep, the UC Irvine trial used the Children's Sleep Habits Questionnaire and daily sleep diaries, whereas the UC Davis study used home-recorded time-lapse videosomnography. Because of the small sample size, the results from both trials are preliminary. They suggest that secretin, porcine or synthetic, does not improve sleep-wake state organization dramatically.