Psychosocial and medical factors associated with intrathecal baclofen pump explants: A case series.

PURPOSE: The goal of this retrospective chart review study was to explore factors that contributed to consideration of or actual pump explantation in pediatric patients with intrathecal baclofen (ITB) pumps. METHODS: Medical records of 30 patients with ITB pumps were reviewed. Quantitative data, including demographic, clinical, psychosocial, and service utilization variables were culled from the records. Qualitative data were collected from clinic visit notes, pump-related follow-up phone calls, and any pump-related emergency room visits. RESULTS: Of those reviewed, six underwent ITB pump explantation, and two considered explantation. Factors contributing to pump explantation or consideration of explantation included the following: postoperative infection, pump malfunction, non-adherence, anxiety/behavioral factors impacting the patient's tolerance of the pump, distance to the medical provider, frequency of required pump refill appointments, lack or perceived lack of intrathecal baclofen effect, and difficulty transitioning to adult care providers. CONCLUSION: Due to the complex care regimen associated with ITB pumps and various psychosocial and logistical factors that impact treatment success, a standardized multidisciplinary pre-implantation education, screening, and assessment process should be developed. Such a process would ensure that patients/families receive appropriate education, including proactively identifying treatment barriers and potential complications, possibly minimizing dissatisfaction with treatment and the need for explantation.

Adolescent Peer Victimization and Physical Health Problems.

OBJECTIVE: Peer victimization (PV) is a key interpersonal stressor that can be traumatizing for youth. This study evaluated the relationships between overt, relational, reputational, and cyber PV and adolescents' somatic complaints and sleep problems. Symptoms of depression and social anxiety were examined as potential mediators. METHOD: Adolescents (N = 1,162; M age = 15.80 years; 57% female; 80% Hispanic) were assessed at three time points, 6 weeks apart, using standardized measures of PV, depression, social anxiety, sleep problems, and somatic complaints. Structural equation modeling evaluated key study aims. RESULTS: Relational, reputational, and cyber PV, but not overt PV, were directly or indirectly associated with subsequent somatic complaints and/or sleep problems. Depression and social anxiety mediated relationships between relational PV and health outcomes, whereas reputational PV was indirectly associated with somatic complaints via depression only. DISCUSSION: The stress of PV may contribute to adolescents' sleep problems and somatic complaints and has implications for pediatric psychologists.

Cyber victimization by peers: Prospective associations with adolescent social anxiety and depressive symptoms.

Peer victimization that occurs via electronic media, also termed cybervictimization, is a growing area of concern for adolescents. The current study evaluated the short-term prospective relationship between cybervictimization and adolescents' symptoms of social anxiety and depression over a six-week period. Participants were 839 high-school aged adolescents (14-18 years; 58% female; 73% Hispanic White), who completed measures of traditional peer victimization, cybervictimization, depression, and social anxiety at two time points. Findings supported the distinctiveness of cybervictimization as a unique form of peer victimization. Furthermore, only cybervictimization was associated with increased levels of depressive symptoms over time, and only relational victimization was associated with increased social anxiety over time, after controlling for the comorbidity of social anxiety and depression among youth. Cybervictimization appears to be a unique form of victimization that contributes to adolescents' depressive symptoms and may be important to target in clinical and preventive interventions for adolescent depression.

Family and youth factors associated with health beliefs and health outcomes in youth with type 1 diabetes.

OBJECTIVE: To examine the association of family organization with metabolic control in adolescents with type 1 diabetes through the mechanisms of family self-efficacy for diabetes and disease management. METHOD: Data from the baseline assessment of a longitudinal RCT were used, wherein 257 adolescent-parent dyads (adolescents aged 11-14) each completed the family organization subscale of the Family Environment Scale, the self-efficacy for Diabetes Self-Management Scale, the Diabetes Behavior Rating Scale, and 2 24-hr diabetes interviews. RESULTS: Structural equation modeling showed greater family organization was associated indirectly with better disease management behaviors via greater family self-efficacy (ß = .38, p < .001). Greater self-efficacy was indirectly associated with better metabolic control via better disease management both concurrently (ß = -.37, p < .001) and prospectively (ß = -.26, p < .001). The full model indicates more family organization is indirectly associated with better metabolic control concurrently and prospectively through greater self-efficacy and better disease management (ß = -.13, p < .001). CONCLUSIONS: Understanding the mechanisms by which family organization is associated with metabolic control provides insight into possible avenues of prevention/intervention for better diabetes management.