[show abstract][hide abstract] ABSTRACT: The study assessed the relationship between a history of child abuse, nonadherence to medications, and medical outcome in children who had a liver transplant.
Abuse history for children and adolescents ages 8 to 21 who underwent a liver transplantation at Mount Sinai Medical Center in New York was obtained in interviews in 2002. Adherence to tacrolimus was assessed from January 1 to December 31, 2003 by computing the SD of a series of medication blood levels for each patient. Biopsy-proven rejection episodes, degree of fluctuation of alanine aminotransferase (ALT), and maximal ALT levels were recorded as indicators of medical outcome.
Of 72 eligible patients, 56 were evaluated. Five had documented abuse. Abused children were less adherent to their medication regimen (p = .02; 95% confidence interval [CI] -2.66 to -0.24), had poor disease control (higher maximal ALT, p <.01; 95% CI -613.72 to -249.55), had greater fluctuation in ALT levels (p <.01; 95% CI -151.19 to -65.91), and suffered more biopsy-proven rejection episodes (two episodes in the abused cohort versus none in the rest) in 2003.
A history of child abuse is a significant risk factor for poor outcome posttransplantation and should be evaluated routinely. Adherence to medications can be a target for intervention in patients with a history of abuse.
Journal of the American Academy of Child & Adolescent Psychiatry 10/2007; 46(10):1280-9. · 6.97 Impact Factor
[show abstract][hide abstract] ABSTRACT: To test the utility of the UCLA posttraumatic stress disorder (PTSD) Index for DSM-IV (U-PTSD-I)(c) for predicting PTSD diagnosis in children with and without medical illnesses. The U-PTSD-I and a standard psychiatric interview were administered to medically ill children (n = 76) and children who experienced other traumatic events (n = 31). We found U-PTSD-I's sensitivity and specificity was better in the nonmedical illness cohort. Only intrusion symptoms were significantly associated with the diagnosis of PTSD in the medically ill. In conclusion, the U-PTSD-I performs better among general trauma versus medically ill patients. Intrusion symptoms should be focused on when assessing PTSD in medically ill children.
Annals of the New York Academy of Sciences 08/2006; 1071:472-7. · 4.38 Impact Factor