Christina Ramey

Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States

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Publications (5)10.69 Total impact

  • Michele Herzer · Christina Ramey · Jennifer Rohan · Sandra Cortina ·
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    ABSTRACT: This paper presents case examples that document the preliminary clinical utility of using electronic monitoring (EM) feedback to tailor empirically validated adherence-promoting interventions, delivered in standard clinical practice. Challenges of utilizing EM in standard clinical practice as well as future directions are also discussed. Two adolescents referred for behavioral adherence promotion intervention are described. Each youth was provided a MEMS® bottle and one oral medication was chosen jointly by the therapist, family, and medical provider for adherence monitoring. Graphical MEMS® feedback was provided to families during intervention visits and subsequently used to tailor adherence interventions to target each family's unique needs. EM feedback was a feasible and clinically rich supplement to adherence-promoting interventions. EM facilitated identification of adherence barriers and successes, and open and non-adversarial discussions regarding adherence between patients, families, and clinicians, and provided real-time representations of patients' medication administration. These case presentations suggest that EM feedback can be a clinically useful tool when used as a supplement to an empirically supported intervention delivered in standard psychological practice aimed at adherence promotion among chronically ill youth.
    Clinical Child Psychology and Psychiatry 09/2011; 17(4):505-18. DOI:10.1177/1359104511421103 · 1.03 Impact Factor
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    ABSTRACT: This report describes an intervention to promote medication adherence and treat comorbid psychological symptoms in a 17 year-old female with Fanconi Anemia. The patient presented with a typical adherence rate estimated at 25% and self-reported symptoms of depressed mood and anxiety. Our comprehensive treatment approach integrated electronic monitoring (EM), an emerging strategy for adherence promotion, and motivational interviewing (MI) within an evidence-based cognitive-behavioral therapy (CBT) framework. We used EM data to assess and track medication adherence. The therapist reviewed these data with the patient and family in session and used MI techniques to promote health behavior change. We analyzed changes in adherence rates over time using a time series analysis (Auto-Regressive Moving Average [ARIMA]). In addition, the patient and her mother reported on depression, anxiety, and quality of life at intake and after 12 months, and the therapist treated psychological symptoms with CBT. The average adherence rate during the baseline EM phase was ~53%. The mean adherence rate across treatment was ~77%, and after 17 months, the final weekly adherence rate was 82%. Adherence rates significantly improved over the treatment period, ARIMA t = 36.16, p < .01. EM feedback and MI are viable additions to CBT to promote medication adherence in adolescence. This approach has the potential to effectively treat adolescents with adherence problems and psychological symptoms across multiple chronic illness diagnoses, and ultimately to improve health and quality of life outcomes.
    Health Psychology 06/2011; 30(5):503-9. DOI:10.1037/a0024020 · 3.59 Impact Factor
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    ABSTRACT: Pai ALH, Ingerski LM, Perazzo L, Ramey C, Bonner M, Goebel J. Preparing for transition? The allocation of oral medication regimen tasks in adolescents with renal transplants. Pediatr Transplantation 2011: 15:9–16. © 2010 John Wiley & Sons A/S. Abstract: A mixed-methods design was utilized to examine strategies that families use to manage the post-transplant oral medication regimen of adolescents with renal transplants. Seventeen adolescents and their caregivers were administered structured interviews assessing the tasks that families identified as comprising the oral medication regimen, how tasks were allocated across family members and how the dyad decided on the allocation of tasks. Adherence was assessed via electronic pill bottles and calculated by dividing the number of doses taken by those prescribed. Patients and their caregivers identified the following tasks as part of the oral medication regimen: filling the pillbox (71%), calling for refills (65%) and verifying that the pillbox is filled correctly (47%). Adult caregivers were primarily responsible for managing the medication regimen for the majority of adolescents (70%). Secondary analyses revealed that the number of oral medication regimen tasks identified by the dyad was significantly associated with patient adherence. Our findings highlight the need to bolster efforts to develop methods to quantitatively assess and promote self-management skills among adolescents with renal transplants.
    Pediatric Transplantation 09/2010; 15(1):9-16. DOI:10.1111/j.1399-3046.2010.01369.x · 1.44 Impact Factor
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    Meg H Zeller · Jennifer Reiter-Purtill · Christina Ramey ·
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    ABSTRACT: It is asserted that the more immediate and observable consequences of pediatric obesity are psychosocial in nature. This study examines the peer relations of clinically referred obese youth compared to demographically comparable nonoverweight peers within the classroom environment. Peer-, teacher-, and self-reports of behavioral reputation (Revised Class Play (RCP)), and peer reports of social acceptance, nonsocial attributes (attractiveness, athleticism, academic competence), and health interference (school absence, illness, fatigue) were obtained regarding 90 obese youth (BMI > 95th percentile; 8-16 years, 57% girls, 50% African American) and 76 nonoverweight demographically similar comparison classmates. Relative to comparison peers, obese children were nominated significantly less often as a best friend and rated lower in peer acceptance, although the two groups did not differ in the number of reciprocated friendships. Obese youth were described by peer, teacher, and self-report as more socially withdrawn and by peers as displaying less leadership and greater aggressive-disruptive behavior. Peers also described obese youth as less physically attractive, less athletic, more sick, tired, and absent from school. Being seen as less attractive and less athletic by peers helped to explain differences in obese and nonoverweight youth's levels of peer acceptance. Clinically referred obese youth are characterized by peer relations that differ from those of nonoverweight youth. The peer environment provides a rich context to understand the social consequences of pediatric obesity as well as factors that could be targeted in intervention to promote more positive health and psychosocial outcomes.
    Obesity 04/2008; 16(4):755-62. DOI:10.1038/oby.2008.4 · 3.73 Impact Factor
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    ABSTRACT: This research examined the emotional, social, and behavioral functioning of children with sickle cell disease (SCD) and classroom comparison peers from the perspective of primary and secondary caregivers. It was hypothesized that children with SCD would have more internalizing (emotional) and social problems and fewer externalizing (behavioral) problems than comparison peers. Caregivers of 70 children with SCD and 67 comparison peers completed the Child Behavior Checklist (CBCL) during visits to the children's homes. Relative to comparison peers, children with SCD were perceived by primary caregivers as having more total and internalizing problems and less total competence. Additionally, significantly more children with SCD exceeded clinical cutoffs on the CBCL. While caregivers of children with SCD perceive these children to be at a slightly elevated risk for problems across multiple domains, a significant number of children with SCD have problems in the clinical range. The authors recommend that vigorous screening programs for mental health problems should be included in the routine care of children with SCD, and programs of psychosocial intervention research should be implemented to ameliorate problems for the children at greatest risk.
    Journal of Pediatric Hematology/Oncology 11/2004; 26(10):642-8. DOI:10.1097/01.mph.0000139456.12036.8d · 0.90 Impact Factor