Core components of a rehabilitation program in pediatric cardiac disease

There is increasing effort in both the inpatient and outpatient setting to improve care, function, and quality of life for children with congenital heart disease, and to decrease complications. As the mortality rates of surgical procedures for congenital heart disease decrease, improvement in perioperative morbidity and quality of life have become key metrics of quality of care. Quality of life and function in patients with congenital heart disease can be affected by multiple factors: the underlying heart condition, cardiac surgery, complications, and medical treatment. Some of the functional areas affected are motor abilities, exercise capacity, feeding, speech, cognition, and psychosocial adjustment. Rehabilitation interventions aim to enhance and restore functional ability and quality of life for those with physical impairments or disabilities. Interventions such as exercise training have been extensively evaluated in adults with acquired heart disease, and rehabilitation interventions for pediatric patients with congenital heart disease have similar potential to improve perioperative morbidity and quality of life. However, literature regarding the pediatric population is limited. We have gathered a multidisciplinary team of experts from major institutions to create evidence- and practice-based guidelines for pediatric cardiac rehabilitation programs in both inpatient and outpatient settings. To improve the quality of life of pediatric patients with congenital heart disease, we propose the use of individualized multidisciplinary rehabilitation programs that include: medical management; neuropsychology; nursing care; rehabilitation equipment; physical, occupational, speech, and feeding therapies; and exercise training

Longitudinal Associations Between Academic Descriptive and Injunctive Norms and Adolescent Achievement

Previous research has shown that adolescent peer groups play a role in maintaining and exacerbating demographic differences in achievement. However, there is still limited knowledge about the malleable factors that contribute to these achievement disparities. This short-term longitudinal study examined one such malleable factor—namely, perceived norms. Participants were 710 Asian American and Hispanic/Latino students in Grades 9 and 10 followed over 1 year. Normative perceptions and academic engagement were measured with adolescent self-report. Grade-point averages and standardized test scores were obtained from school records. Path analyses showed that injunctive norms (perception of the acceptability of academic effort), but not descriptive norms (perception of peers’ typical academic effort), significantly accounted for racial/ ethnic group differences in self-reported engagement and standardized test scores. This study indicates that perceived norms may contribute to racial/ethnic differences in educational outcomes

Cross-Ethnic Friendships, Intergroup Attitudes, Intragroup Social Costs, and Depressive Symptoms among Asian-American and Latino-American Youth

As American school districts become increasingly diverse, understanding the processes that promote positive intergroup relations is a critical task. The role of cross-ethnic friendships is one important factor, given the significance of these reciprocated peer relationships for social development. The current study examines the short-term longitudinal impact of cross-ethnic friendships on peer group attitudes and emotional adjustment. 524 student participants (54.8% female; M age  = 15.06 years, SD  = 0.75; 47% Latino, 53% Asian-American) were followed for one year with two spring data collections. Students completed a self-report inventory assessing depressive symptoms and a peer nomination inventory assessed friendship, liking, disliking, popularity, and unpopularity. Cross-ethnic friendships were predictive of positive attitudes toward peers from other ethnic/racial groups and were also linked to declines in depressive symptoms for boys. Moreover, these positive effects did not come at a social cost, as cross-ethnic friendships were not associated with rejection by same-ethnic peers. Cross-ethnic friendships provide a unique environment that contributes to positive intergroup attitudes and beneficial socioemotional development for some youth

Academic Functioning and Peer Influences: A Short‐Term Longitudinal Study of Network–Behavior Dynamics in Middle Adolescence

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136385/1/cdev12611_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136385/2/cdev12611.pd

Popularity Among Peer Role Models: A Moderator of Peer Victimization and Depressive Symptoms

This short-term, longitudinal study examines evidence that the level of popularity among adolescents' peer role models exacerbates the emotional impact of mistreatment by peers. We recruited 469 adolescents (255 boys, 214 girls; (X) over bar age = 12.7 years) from an ethnically diverse middle school and followed these youth for a 1-year period. We collected identical measurement batteries in two consecutive waves. Participants completed a self-report assessment of depressive symptoms, as well as a peer-nomination inventory identifying victimized and popular classmates. The inventory also included items asking adolescents to identify peers they want to be like, respect, and admire. High popularity levels among peer role models were associated with intensified associations between peer victimization and depressive symptoms. However, these findings held only for boys. Taken together, these results suggest that victimization by peers is most detrimental for adolescent boys who seek to identify with their more socially dominant classmates

Unpopularity with same- and cross-ethnicity peers as predictors of depressive symptoms during adolescence

This longitudinal study examined associations between perceptions of unpopularity with same- and cross-ethnicity peers and depressive symptoms in an ethnically diverse adolescent peer group. Participants were 393 Vietnamese and Mexican American adolescents (209 boys, 184 girls; Mage = 15.04 years, SD = 0.73, age range: 14–17 years) followed across two consecutive school years. Participants completed a demographic survey, self-report measures of depressive symptoms and ethnic identity, and a peer-nomination inventory assessing unpopularity. Unpopularity with same-ethnicity peers predicted increases in depressive symptoms for boys but not girls. Cross-ethnicity attitudes were not predictive of psychological difficulties. The findings of this study provide the first known evidence that, for boys, perceptions of unpopularity by same-ethnicity peers may be a more significant threat to emotional functioning than similar perceptions by peers of a different ethnicity. Results indicate that a nuanced perspective on risk mechanisms accounting for same- and cross-ethnic relations and gender may be warranted. •Unpopularity with same-ethnicity peers predicted depressive symptoms for boys.•Cross-ethnicity attitudes were not predictive of psychological difficulties.•Ethnic identity did not emerge as a moderator

Impaired Neurovascular Function Underlies Poor Neurocognitive Outcomes and Is Associated with Nitric Oxide Bioavailability in Congenital Heart Disease

We use a non-invasive MRI proxy of neurovascular function (pnvf) to assess the ability of the vasculature to supply baseline metabolic demand, to compare pediatric and young adult congenital heart disease (CHD) patients to normal referents and relate the proxy to neurocognitive outcomes and nitric oxide bioavailability. In a prospective single-center study, resting-state blood-oxygen-level-dependent (BOLD) and arterial spin labeling (ASL) MRI scans were successfully obtained from 24 CHD patients (age = 15.4 ± 4.06 years) and 63 normal referents (age = 14.1 ± 3.49) years. Pnvf was computed on a voxelwise basis as the negative of the ratio of functional connectivity strength (FCS) estimated from the resting-state BOLD acquisition to regional cerebral blood flow (rCBF) as estimated from the ASL acquisition. Pnvf was used to predict end-tidal CO2 (PETCO2) levels and compared to those estimated from the BOLD data. Nitric oxide availability was obtained via nasal measurements (nNO). Pnvf was compared on a voxelwise basis between CHD patients and normal referents and correlated with nitric oxide availability and neurocognitive outcomes as assessed via the NIH Toolbox. Pnvf was shown as highly predictive of PETCO2 using theoretical modeling. Pnvf was found to be significantly reduced in CHD patients in default mode network (DMN, comprising the ventromedial prefrontal cortex and posterior cingulate/precuneus), salience network (SN, comprising the insula and dorsal anterior cingulate), and central executive network (CEN, comprising posterior parietal and dorsolateral prefrontal cortex) regions with similar findings noted in single cardiac ventricle patients. Positive correlations of Pnvf in these brain regions, as well as the hippocampus, were found with neurocognitive outcomes. Similarly, positive correlations between Pnvf and nitric oxide availability were found in frontal DMN and CEN regions, with particularly strong correlations in subcortical regions (putamen). Reduced Pnvf in CHD patients was found to be mediated by nNO. Mediation analyses further supported that reduced Pnvf in these regions underlies worse neurocognitive outcome in CHD patients and is associated with nitric oxide bioavailability. Impaired neuro-vascular function, which may be non-invasively estimated via combined arterial-spin label and BOLD MR imaging, is a nitric oxide bioavailability dependent factor implicated in adverse neurocognitive outcomes in pediatric and young adult CHD