Death in the pediatric intensive care unit (PICU) is often unexpected by parents who are hoping for recovery with use of aggressive therapies. Parents' preparedness for death may be less than in other clinical settings such as pediatric oncology or palliative care. This study sought to investigate the extent of complicated grief symptoms and associated risk factors among parents whose child died in a PICU. Parents had a high level of complicated grief symptoms 6 months after their child's death. Fifty-nine percent of parents had scores indicative of complicated grief. Risk factors for complicated grief included being the biological mother or female guardian of the child, trauma as the cause of death, greater attachment-related anxiety and avoidance, and greater grief avoidance. Better understanding of the prevalence and risk factors of complicated grief among parents will allow those most vulnerable to maladaptive grief responses to receive professional bereavement support.
The GEMS program sought to address the need for effective interventions that target preadolescent African American girls through development and evaluation of culturally appropriate obesity prevention approaches. The Memphis trial used group behavioral counseling to promote healthy eating and increased physical activity (obesity prevention intervention) or self-esteem and social efficacy (alternative intervention). Ninety-minute sessions occurred weekly for 14 weeks and then monthly for 20 months (34 sessions over 2 years). Body mass index increased in all girls, with no treatment effect (obesity prevention minus alternative) at 2 years (mean, 0.09; 95% CI: −0.40 to 0.58). Two-year treatment effects in the expected direction were observed for servings per day of sweetened beverages, water, and vegetables but there were no effects on physical activity. Post hoc analyses suggested a treatment effect in younger girls, indicating that preventive interventions may need to start well before puberty.
Predicted mean body mass index (BMI) from post hoc repeated-measures analysis of 3-way interactions for age, visit, and treatment group. Brackets show mean treatment group differences at 2 years with 95% CIs.
The Stanford GEMS trial was a 2-arm, parallel group, randomized controlled trial to test the efficacy of a culturally tailored after-school dance program and a family-based intervention to reduce television, videotape, and video game use to reduce body mass index gain in preadolescent African American girls with lower socioeconomic status. The GEMS Jewels After School Dance Intervention was offered for 2.5 hours 5 days per week, 12 months per year at community centers in selected neighborhoods. The intervention also included a home-based screen time reduction intervention designed to incorporate African or African American history and culture. Changes in body mass index did not differ between groups (adjusted mean difference, 0.04; 95% CI, −0.18 to 0.27 per year). Among secondary outcomes, fasting total cholesterol levels, low-density lipoprotein cholesterol levels, incidence of hyperinsulinemia, and depressive symptoms fell more among girls in the dance and screen time reduction intervention. The results indicate a need for continued solution-oriented research to identify approaches and methods that produce greater effects in population-based samples of children.
Sample distributions of fasting insulin by intervention group at baseline and follow-up. Percentages of the dance and screen time reduction sample and the health education sample with fasting insulin levels higher than the corresponding threshold level on the horizontal axis are shown.
This Month in Archives of Pediatrics & Adolescent Medicine. Arch Pediatr Adolesc Med. 2010;164(11):993. doi:10.1001/archpediatrics.2010.198