ABSTRACT
Introduction: Overweight and obesity in youth with serious emotional disturbance (SED) is exceedingly common. In 2015 the AHA called attention to mental illnesses in youth as important risk conditions for early CVD and the need for transformational change in management of overweight and obesity in this group. Our objective was to test a 12-month, innovative healthy weight intervention in youth with SED.Hypothesis: The active intervention is more effective than control in decreasing BMI Z-score compared at 12 m. Method(s): We conducted a two-arm randomized trial in 2 outpatient pediatric mental health settings in 112 youth, ages 8-18 yrs. The active intervention group was offered 12m of in-person and virtual individual weight management sessions led by health coaches who provided guidance on improving diet and increasing physical activity, and engaged parents. Result(s): At baseline, mean (SD) age was 13.0 (2.7) yrs with 46% ages 8-12 and 54% 13-18;55% were male, 46% Black, 39% had household income less than $50K/yr and 31% lived in a single-parent household. Primary diagnoses were ADHD (41%), major depression (23%), and anxiety (23%). Mean BMI Z-score (SD) was 2.0(0.4), BMI 30.4 (6.4) kg/m2.Mean(SD) psychotropic medications were 2.1(1.4).At 12m, 111 (99%) had a follow-up weight;42 were collected after the onset of the COVID pandemic). The intervention group compared to the control group had 0.15 decrease in BMI Z-Score (95% CI 0.26 to 0.04), p<0.007) between baseline and 12 m (Figure) and a 1.43 kg/m2 decrease in BMI (95% CI 2.43, 0.42, p<0.006). Estimated net effect on BMI Z-score for intervention vs. control was enhanced during the pandemic but not statistically different from net effects pre-pandemic (p=0.06). Conclusion(s): A weight control intervention designed for children with SED decreased BMI Z-score substantially over 12 months, including during the COVID-19 pandemic. These results provide empirical evidence in support of weight control programs in a population at high risk for early development of CVD risk factors.
ABSTRACT
Background: Adherence is critical in chronic kidney disease (CKD) to delay progression to kidney failure. Treatment plans for CKD can include medications, diet, and exercise. Overall adherence to treatment is low in CKD, and also as few as 40% of new kidney failure patients have any documented CKD-related care. The purpose of this study was to explore CKD patients' experiences of adherence to treatment plans and what role their healthcare providers had in supporting adherence. Methods: As part of a larger mixed-methods study of Chronic Renal Insufficiency Cohort (CRIC) study participants, a subset was randomly selected for 1:1 interviews. All CRIC participants are >45 years with CKD stages 1-4, and this sample consisted of University of Pennsylvania participants interviewed in 2019-2020. Participants described their experiences with adherence and what they have done when experiencing difficulty. Interviews were recorded, transcribed, and coded using conventional content analysis. Results: The sample (n=32) had a mean age of 67 years, 53% women, 59% nonwhite. After analysis of factors relevant to treatment planning and adherence, four themes emerged: patient factors (multiple chronic conditions, motivation, outlook), provider factors (attentiveness, availability, communication), treatment planning factors (lack of plan, proactive patient research, provider-focused goals, and shared decision making), and patient responses to the treatment plan (disagreeing with treatment, frustration with their lack of adherence [I know what to do], lack of information, and positive feedback). Patients also described the impact of COVID on access to care and the positive impact of family, ancillary providers, and routines/habits. Conclusions: These themes align with behavioral learning theory, which includes: internal antecedents (patient factors), external antecedents (provider factors), behavior (treatment planning and attempts at adherence), and consequences (adherence and responses to the treatment plan). Our results provide many potential points of intervention to support treatment adherence in CKD, and a tailored approach is needed to address patients' specific adherence factors.