Perceiving Pain in Others: Automatic and Controlled Mechanisms

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The cross-cultural process of adapting observational tools for pediatric pain assessment: the case of the Dental Discomfort Questionnaire

Abstract Background A rigorous cross-cultural adaptation process of an existing instrument could be the best option for measuring health in different cultures, instead of developing a new tool, and prior to psychometric and validation testing. The Dental Discomfort Questionnaire (DDQ), a validated instrument for assessing toothache in young children, has not been cross-culturally adapted so far. This study aimed to explore the detailed phases of the cross-cultural adaptation process of a pain assessment tool, presenting the example of the DDQ Brazilian-Portuguese adapted version. Methods The study design was based on the universalist approach, which consists of a sequential analysis to assess the relevant phases of a cross-cultural process before testing the measures of the instrument: conceptual, item, semantic, and operational equivalences. Systematic information was gathered from the literature, expert discussions, translations, and pre-testing through cognitive interviews with Brazilian population. Results Detailed description of the three major phases for a cross-cultural adaptation process was given. Notes of the changes done in the structure of the presented instrument (DDQ) were specifically pointed out at each phase. Conceptual and item analyses showed that there are similarities in the DDQ construct between the original and Brazilian cultures that require minor modifications. Translations and back-translations allowed the development of the preliminary Brazilian-Portuguese version of the DDQ, which was tested and underwent other minor changes to improve its comprehensibility. Conclusions Describing the phases was important to show how changes are made in a cross-cultural adaptation process of an instrument. This also could help researchers in adapting similar pediatric pain assessment tools to different cultures. A Brazilian-Portuguese version of the DDQ was presented

Longitudinal Patterns of HBA1c Trajectories in Patients with Type 1 Diabetes

Introduction: Type 1 diabetes is a chronic condition that affects adolescents’ quality of life and raises the risk of developing mental health concerns and diabetes-related complications. Measuring glycated hemoglobin (HbA1c) over time is the standard of care within the management of type 1 diabetes; however, the determinants of different HbA1c trajectories remain poorly understood. In the secondary analysis of the data collected for the Integrated Care Model (1), we aimed to identify groups of HbA1c trajectories with similar trends and examine the association between these groups and demographic and psychosocial variables. Methods: HbA1c data were collected at 4 consecutive time points with a gap of 3±1 months. We used Leffondré’s method (2) and Group-based trajectory modeling (GBTM) (3) to derive the groups of HbA1c trajectories among 91 adolescents. Baseline characteristics of the adolescents included in the groups were analyzed by univariate analysis. Results: Leffondré’s method identified three groups of trajectories: stable (63%), decreasing (17%), and increasing (20%). The baseline HbA1c levels for the three groups were 8.00±0.93, 10.07±1.63, and 8.21±1.14, respectively. Among the baseline characteristics, only the treatment method distinguished the groups of adolescents with similar trajectories of HbA1c over time (p=0.015). The GBTM method identified similar groups: stable (67%), decreasing (18%) and increasing (15%). The baseline HbA1c levels for the three groups were 7.89±0.88, 9.81±1.61, and 9.00±1.38, respectively. Groups produced by GBTM were also distinguished by treatment modality at baseline (p=0.022). Discussion: We identified three distinct patterns of HbA1c trajectories in adolescents. The only baseline characteristic that significantly distinguished these trajectories was the treatment modality. References J. Versloot, et al., An Integrated Care Model to Support Adolescents With Diabetes-related Quality-of-life Concerns: An Intervention Study. Can J Diabetes (2022). K. Leffondré, et al., Statistical measures were proposed for identifying longitudinal patterns of change in quantitative health indicators. J Clin Epidemiol 57, 1049–1062 (2004). D. S. Nagin, Group-based trajectory modeling: an overview. Ann Nutr Metab 65, 205–210 (2014)

Using Person-Reported Outcomes (PROs) to Motivate Young People with Diabetes

Purpose of Review: This manuscript describes how person-reported outcomes (PROs) can be utilized in care for young people with diabetes in the context of motivation. Recent Findings: The use of person-reported outcome measures (PROMS) in clinical care is feasible and acceptable, and helps focus the clinical encounter on life domains important to the person with diabetes. Results with regard to impact on self-management and glycemic outcomes are limited. Motivation is an important factor for self-management. Based on self-determination theory, autonomy-supportive, person-centered, and collaborative communication by diabetes care providers is associated with better outcomes. PROMs can facilitate this conversation. Summary: Understanding of youth motivation for maintaining or improving self-management behaviors requires a person-centered approach. PROMs can be used to facilitate an autonomy-supportive and person-centered conversation in clinical care. Training diabetes care providers in autonomy-supportive, person-centered conversation skills to discuss PROs might help to tap into youth’s motivation, but further research is needed

Using Person-Reported Outcomes (PROs) to Motivate Young People with Diabetes

PURPOSE OF REVIEW: This manuscript describes how person-reported outcomes (PROs) can be utilized in care for young people with diabetes in the context of motivation. RECENT FINDINGS: The use of person-reported outcome measures (PROMS) in clinical care is feasible and acceptable, and helps focus the clinical encounter on life domains important to the person with diabetes. Results with regard to impact on self-management and glycemic outcomes are limited. Motivation is an important factor for self-management. Based on self-determination theory, autonomy-supportive, person-centered, and collaborative communication by diabetes care providers is associated with better outcomes. PROMs can facilitate this conversation. Understanding of youth motivation for maintaining or improving self-management behaviors requires a person-centered approach. PROMs can be used to facilitate an autonomy-supportive and person-centered conversation in clinical care. Training diabetes care providers in autonomy-supportive, person-centered conversation skills to discuss PROs might help to tap into youth's motivation, but further research is needed.status: publishe

Dental discomfort questionnaire:its use with children with a learning disability

This study investigated whether the behaviors from the Dental Discomfort Questionnaire (DDQ) could help identify toothaches in children with a learning disability, who have a limited capacity to self-report. The objectives were to examine whether the behaviors from the DDQ occur more often in children with a learning disability who have caries and a toothache than in children who do not have caries and a toothache; and secondly, to examine whether two additional items increase the specificity and sensitivity of the DDQ to recognize a toothache, in this particular population of children with a learning disability. The DDQ was completed by a convenience sample of 58 parents on behalf of their children: 31% girls, aged between 6 and 13 years (mean = 7.5, SD = 2.7). Of the total group, 26% (n = 15) suffered from a toothache and 43% (n = 25) had carious teeth. Children with caries and a toothache had a significantly higher mean DDQ score and displayed more toothache-related behaviors (e.g., problems with chewing, problems with brushing teeth) than children without caries or toothache. The DDQ seems to be a functional and easy-to-use instrument to alert parents to the presence of a toothache in this specific group of children with a learning disability

Screening preschool children with toothache: validation of the Brazilian version of the Dental Discomfort Questionnaire

Abstract Background The Dental Discomfort Questionnaire (DDQ) is an observational instrument intended to measure dental discomfort and/or pain in children under 5 years of age. This study aimed to validate a previously cross-culturally adapted version of DDQ in a Brazilian children sample. Methods Participants included 263 children (58.6% boys, mean age 43.5 months) that underwent a dental examination to assess dental caries, and their parent that filled out the cross-culturally adapted DDQ on their behalf. Exploratory factor analysis (principal component analysis form) and psychometric tests were done to assess instrument’s dimensionality and reliability. Results Exploratory factor analysis revealed a multidimensional instrument with 3 domains: ‘eating and sleeping problems’ (Cronbach’s alpha 0.81), ‘earache problems’ (alpha 0.75), and ‘problems with brushing teeth’ (alpha 0.78). The assessment had excellent stability (weighted-kappa varying from 0.68 to 0.97). Based on the factor analysis, the model with all 7 items included only in the first domain (named DDQ-B) was further explored. The items and total median score of the DDQ-B were related to parent-reported toothache and the number of decayed teeth, demonstrating good construct and discriminant validities. Conclusions DDQ-B was proven a reliable pain assessment tool to screen this group of Brazilian children for caries-related toothache, with good psychometric properties

Children’s Behavioral Pain Cues: Implicit Automaticity and Control Dimensions in Observational Measures

Some pain behaviors appear to be automatic, reflexive manifestations of pain, whereas others present as voluntarily controlled. This project examined whether this distinction would characterize pain cues used in observational pain measures for children aged 4–12. To develop a comprehensive list of cues, a systematic literature search of studies describing development of children’s observational pain assessment tools was conducted using MEDLINE, PsycINFO, and Web of Science. Twenty-one articles satisfied the criteria. A total of 66 nonredundant pain behavior items were identified. To determine whether items would be perceived as automatic or controlled, 277 research participants rated each on multiple scales associated with the distinction. Factor analyses yielded three major factors: the “Automatic” factor included items related to facial expression, paralinguistics, and consolability; the “Controlled” factor included items related to intentional movements, verbalizations, and social actions; and the “Ambiguous” factor included items related to voluntary facial expressions. Pain behaviors in observational pain scales for children can be characterized as automatic, controlled, and ambiguous, supporting a dual-processing, neuroregulatory model of pain expression. These dimensions would be expected to influence judgments of the nature and severity of pain being experienced and the extent to which the child is attempting to control the social environment.Peer Reviewe