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Danville, PA, United States

Chronis-Tuscano A.,University of Maryland College Park | Clarke T.L.,University of Maryland College Park | O'Brien K.A.,University of Maryland College Park | Raggi V.L.,University of Maryland College Park | And 14 more authors.
Journal of Consulting and Clinical Psychology | Year: 2013

Objective: More than 50% of mothers of children with attention-deficit/ hyperactivity disorder (ADHD) have a lifetime history of major depressive disorder (MDD). Maternal depressive symptoms are associated with impaired parenting and predict adverse developmental and treatment outcomes for children with ADHD. For these reasons, we developed and examined the preliminary efficacy of an integrated treatment targeting parenting and depressive symptoms for mothers of children with ADHD. This integrated intervention incorporated elements of 2 evidence-based treatments: behavioral parent training (BPT) and cognitive behavioral depression treatment. Method: Ninety-eight mothers with at least mild depressive symptoms were randomized to receive either standard BPT (n = 51) or the integrated parenting intervention for ADHD (IPI-A; n = 47). Participants were assessed at baseline, posttreatment, and 3- to 6-month follow-up on measures of (a) self-reported maternal depressive symptoms, (b) observed positive and negative parenting, and (c) observed and mother-reported child disruptive behavior and mother-reported child and family impairment. Results: The IPI-A produced effects of small to moderate magnitude relative to BPT on maternal depressive symptoms, observed negative parenting, observed child deviance, and child impairment at posttreatment and on maternal depressive symptoms, child disruptive behavior, child impairment and family functioning at follow-up. Contrary to expectations, the BPT group demonstrated moderate to large effects relative to IPI-A on observed positive parenting at follow-up. Conclusions: This treatment development study provides encouraging preliminary support for the integrated intervention targeting parenting and depressive symptoms in mothers of children with ADHD. Future studies should examine whether this integrated intervention improves long-term developmental outcomes for children with ADHD. © 2013 American Psychological Association.

Lingren T.,Cincinnati Childrens Hospital Medical Center | Thaker V.,Boston Childrens Hospital | Brady C.,Cincinnati Childrens Hospital Medical Center | Brady C.,Vanderbilt University | And 20 more authors.
Applied Clinical Informatics | Year: 2016

Objective: The objective of this study is to develop an algorithm to accurately identify children with severe early onset childhood obesity (ages 1-5.99 years) using structured and unstructured data from the electronic health record (EHR). Introduction: Childhood obesity increases risk factors for cardiovascular morbidity and vascular disease. Accurate definition of a high precision phenotype through a standardize tool is critical to the success of large-scale genomic studies and validating rare monogenic variants causing severe early onset obesity. Data and Methods: Rule based and machine learning based algorithms were developed using structured and unstructured data from two EHR databases from Boston Children’s Hospital (BCH) and Cincinnati Children’s Hospital and Medical Center (CCHMC). Exclusion criteria including medications or comorbid diagnoses were defined. Machine learning algorithms were developed using cross-site training and testing in addition to experimenting with natural language processing features. Results: Precision was emphasized for a high fidelity cohort. The rule-based algorithm performed the best overall, 0.895 (CCHMC) and 0.770 (BCH). The best feature set for machine learning employed Unified Medical Language System (UMLS) concept unique identifiers (CUIs), ICD-9 codes, and RxNorm codes. Conclusions: Detecting severe early childhood obesity is essential for the intervention potential in children at the highest long-term risk of developing comorbidities related to obesity and excluding patients with underlying pathological and non-syndromic causes of obesity assists in developing a high-precision cohort for genetic study. Further such phenotyping efforts inform future practical application in health care environments utilizing clinical decision support. © Schattauer 2016.

Lee K.-Y.,Obesity Institute | Kang H.-S.,Sungkyunkwan University | Shin Y.-A.,Dankook University
Gene | Year: 2013

The effects of exercise on adiponectin levels have been reported to be variable and may be attributable to an interaction between environmental and genetic factors. The single nucleotide polymorphisms (SNP) 45 (T > G) and SNP276 (G > T) of the adiponectin gene are associated with metabolic risk factors including adiponectin levels. We examined whether SNP45 and SNP276 would differentially influence the effect of exercise training in middle-aged women with uncomplicated obesity. We conducted a prospective study in the general community that included 90 Korean women (age 47.0 ± 5.1. years) with uncomplicated obesity. The intervention was aerobic exercise training for 3. months. Body composition, adiponectin levels, and other metabolic risk factors were measured. Prior to exercise training, only body weight differed among the SNP276 genotypes. Exercise training improved body composition, systolic blood pressure, maximal oxygen consumption, high-density lipoprotein cholesterol, and leptin levels. In addition, exercise improved adiponectin levels irrespective of weight gain or loss. However, after adjustments for age, BMI, body fat (%), and waist circumference, no differences were found in obesity-related characteristics (e.g., adiponectin) following exercise training among the SNP45 and the 276 genotypes. Our findings suggest that aerobic exercise affects adiponectin levels regardless of weight loss and this effect would not be influenced by SNP45 and SNP276 in the adiponectin gene. © 2012.

Benotti P.N.,Obesity Institute
Patient Preparation for Bariatric Surgery | Year: 2014

Patient Preparation for Bariatric Surgery provides a comprehensive and state of the art review of all aspects of the patient preparation process, The text reviews current literature and controversies involving sources of referrals and the difficulties encountered by primary care physicians in managing patients with extreme obesity. Strategies for addressing this problem and integrating primary care physicians in comprehensive obesity programs are presented. The text also reviews current indications for surgery and the current patient access limitations that have resulted in the need for revised surgical indications based more on medical need than mere extent of obesity. Written by an authority in the field, Patient Preparation for Bariatric Surgery is a valuable resource for bariatric surgeons, bariatric physicians and all allied health personnel who manage patients with extreme obesity and will assist in the advancement of this area of surgery as well as stimulate new discovery. © Springer Science+Business Media New York 2014. All rights reserved.

Kelleher D.C.,The Surgical Center | Merrill C.T.,Child Health Advocacy Institute | Cottrell L.T.,Child Health Advocacy Institute | Nadler E.P.,The Surgical Center | And 2 more authors.
JAMA Pediatrics | Year: 2013

Objectives: To determine the current rate of inpatient bariatric surgical procedures among adolescents and to analyze national trends of use from 2000 to 2009. Design: Retrospective cross-sectional study. Setting: Discharge data obtained from the Healthcare Cost and Utilization Project Kids' Inpatient Database, 2000 through 2009. Participants: Adolescents (defined herein as individuals aged 10-19 years) undergoing inpatient bariatric procedures. Intervention: Inpatient bariatric surgery. Main Outcome Measures: The primary outcome measure was the national population-based bariatric procedure rate. The secondary outcome measures were trends in procedure rates and type, demographics, complication rate, length of stay, and hospital charges from 2000 through 2009. Results: The inpatient bariatric procedure rate increased from 0.8 per 100 000 in 2000 to 2.3 per 100 000 in 2003 (328 vs 987 procedures) but did not change significantly in 2006 (2.2 per 100 000) or 2009 (2.4 per 100 000), with 925 vs 1009 procedures. The use of laparoscopic adjustable gastric banding approached one-third (32.1%) of all procedures by 2009. The cohort was predominantly female and older than 17 years. The prevalence of comorbidities increased from 2003 (49.3%) to 2009 (58.6%) (P=.002), while the complication rate remained low and the in-hospital length of stay decreased by approximately 1 day (P<.001). Increasing numbers of patients had Medicaid as their primary payer source; however, most (68.3% in 2009) had private insurance. Conclusions: Despite the worsening childhood obesity epidemic, the rate of inpatient bariatric procedures among adolescents has plateaued since 2003. The predominant procedure type has changed to minimally invasive techniques, including laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass. Trends show low complication rates and decreasing length of stay, despite increasing comorbid conditions among patients. © 2013 American Medical Association.

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