Caregiver self-efficacy providing nutritional support for pediatric patients undergoing hematopoietic stem cell transplant is associated with psychosocial factors

IntroductionCaregiver self-efficacy in providing nutritional support to pediatric hematopoietic stem cell transplantation (HSCT) patients has been little studied despite the increased risk of these children potentially being over- or under-nourished after HSCT, and nutritional status could possibly affect treatment outcomes. The current study aimed to describe caregiver dietary self-efficacy and its associated psychosocial factors and barriers to following dietary recommendations.MethodsCaregivers completed questionnaires pre-HSCT and 30 days, 100 days, and one year post-HSCT. A subset provided a 24-h recall of food intake.ResultsResults showed generally high caregiver confidence and low difficulty supporting their child nutritionally. However, lower confidence was associated with higher caregiver depression, anxiety, and stress 30 days post-HSCT. Further, higher difficulty at various time points was correlated with lower income, higher depression and anxiety, stress, and miscarried helping (i.e., negative caregiver-child interactions surrounding eating), as well as child overweight status and failure to meet protein intake guidelines. Nutritional criteria for protein, fiber, added sugar, and saturated fat were met by 65%, 0%, 75%, and 75%, respectively. Caregiver attitudes and child behavior were the most frequently reported barriers to healthy eating.DiscussionResults suggest that directing resources to caregivers struggling emotionally, economically, or transactionally could support pediatric patients undergoing HSCT in maintaining optimal nutritional status

Predictors of Alcohol Use after Bariatric Surgery

Patients undergoing bariatric surgery are at risk for devloping an alcohol use disorder (AUD). The purpose of this study was to investigate pre-surgical psychosocial risk factors for post-surgical alcohol consumption and hazardous drinking. Participants (N = 567) who underwent bariatric surgery between 2014 and 2017 reported their post-surgical alcohol use. Information was collected from the pre-surgical evaluation including history of alcohol use, psychiatric symptoms, and maladaptive eating behaviors (i.e., binge eating, purging, and emotional eating). Younger age and pre-surgical alcohol use predicted post-surgical alcohol use and hazardous drinking. In addition, higher levels of depressive symptoms and maladaptive eating patterns predicted post-surgical binge drinking. Clinicians conducting pre-surgical psychosocial evaluations should be aware of the multiple risk factors related to post-surgical problematic alcohol use. Future research should evaluate whether preventive interventions for high-risk patients decrease risk for post-surgical alcohol misuse

Metabolic Profiling of a Mapping Population Exposes New Insights in the Regulation of Seed Metabolism and Seed, Fruit, and Plant Relations

To investigate the regulation of seed metabolism and to estimate the degree of metabolic natural variability, metabolite profiling and network analysis were applied to a collection of 76 different homozygous tomato introgression lines (ILs) grown in the field in two consecutive harvest seasons. Factorial ANOVA confirmed the presence of 30 metabolite quantitative trait loci (mQTL). Amino acid contents displayed a high degree of variability across the population, with similar patterns across the two seasons, while sugars exhibited significant seasonal fluctuations. Upon integration of data for tomato pericarp metabolite profiling, factorial ANOVA identified the main factor for metabolic polymorphism to be the genotypic background rather than the environment or the tissue. Analysis of the coefficient of variance indicated greater phenotypic plasticity in the ILs than in the M82 tomato cultivar. Broad-sense estimate of heritability suggested that the mode of inheritance of metabolite traits in the seed differed from that in the fruit. Correlation-based metabolic network analysis comparing metabolite data for the seed with that for the pericarp showed that the seed network displayed tighter interdependence of metabolic processes than the fruit. Amino acids in the seed metabolic network were shown to play a central hub-like role in the topology of the network, maintaining high interactions with other metabolite categories, i.e., sugars and organic acids. Network analysis identified six exceptionally highly co-regulated amino acids, Gly, Ser, Thr, Ile, Val, and Pro. The strong interdependence of this group was confirmed by the mQTL mapping. Taken together these results (i) reflect the extensive redundancy of the regulation underlying seed metabolism, (ii) demonstrate the tight co-ordination of seed metabolism with respect to fruit metabolism, and (iii) emphasize the centrality of the amino acid module in the seed metabolic network. Finally, the study highlights the added value of integrating metabolic network analysis with mQTL mapping

Support for screening and intervening on adolescent depression: Provider-reported training outcomes

Given the potential consequences of untreated adolescent depression and the prevalence of untreated mental health among adolescents, the American Academy of Pediatrics has strongly recommended active support and monitoring of depressive symptoms in pediatric primary care. Primary care providers (PCPs), however, do not have sufficient training to provide this level of care, contributing to low rates of identification and management of depression. The purpose of the current pilot study was to evaluate a training aimed at supporting providers in the management of adolescent depression. Results demonstrated that providers were accepting of the training and that provider knowledge of depression management increased. In comparison to pre-training perceptions, the providers perceived adolescent depression management as more feasible. Providers also reported that they were more comfortable managing depression by the end of the training. Limitations of the current study and future directions are discussed

The association between burnout and pediatrician management of adolescent depression

Objective: Given the increased demand for pediatric primary care providers to manage adolescent depression, the current study examines the association between burnout and provider comfort and perception of feasibility managing adolescent depression. Method: Data were collected from 52 pediatricians at a Midwest academic health center. Results: Higher scores on depersonalization were associated with lower provider-reported comfort managing adolescent depression. Emotional exhaustion and personal accomplishment were not associated with provider-reported comfort managing adolescent depression. None of the burnout domains were associated with the provider-reported perception of the feasibility managing adolescent depression in this setting. Limitations and recommendations for future research regarding the impact of behavioral health training on burnout are discussed. Conclusions: The interpersonal stress dimension of burnout is associated with less comfort managing depression. Adding positive systematic interventions, such as behavioral health trainings that support pediatricians in the management of behavioral health may have impact on burnout

Tracing the missteps of stepped care: Improving the implementation of stepped care through contextual behavioral science

Stepped care is an organizational model of healthcare service provision that organizes interventions into a hierarchy from least-to-most intensive, intrusive, and costly. The intervention intensity should be based on feasibility, cost, severity of the presenting case, and patient and clinician preferences. Patients can be “stepped” up or down, depending on progress. Despite the rich, theoretical literature suggesting the effectiveness of stepped care, its implementation is accompanied by challenges that impede its proliferation in applied settings. This paper provides a review of the barriers to stepped care, including negative perceptions, tendency toward defensive medicine, lack of guidance in decision-making, the need for measurement tools designed for stepped care, and healthcare system factors that discourage stepped care. Specific recommendations are discussed for how a contextual behavioral science approach can reduce barriers to implementing stepped care models of behavioral health service delivery

Quality Improvement and applied behavior analysis: Another name for a rose that smells just as sweet

While the field of applied behavior analysis (ABA) has demonstrated its effectiveness and applicability across multiple settings, there are still concerns within the field about its limited scope. To date, most of the recommendations for expanding the scope of ABA include integrating into other fields that require additional credentials and training. This could be both costly and time consuming. Given the changing landscape of healthcare systems globally, there has been a major emphasis on the use of quality improvement (QI) to enhance overall patient care. Behavior analysts have the skills and training to improve upon the current state of QI. We discuss the overlapping theoretical and methodological similarities between QI and ABA as an additional avenue for behavior analysts to expand their scope of practice. Suggestions and implications of ABA integrating into QI roles are discussed