Psychological functioning, nonadherence and health outcomes after pediatric liver transplantation
Psychological functioning, nonadherence and health outcomes after pediatric liver transplantation
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DOI：
10.1111/j.1600-6143.2007.01878.x
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发表时间：
2007-08-01
影响因子：
8.8
通讯作者：
Opipari-Arrigan, L.
中科院分区：
文献类型：
--
作者：
Fredericks, E. M.;Lopez, M. J.;Opipari-Arrigan, L.
本研究对肝移植后5年内儿童的遵医行为与HRQOL、亲子心理功能、家庭功能的关系进行了实证研究，并探讨了遵医行为与健康结局的关系。研究对象包括38名儿童(平均8.5岁，年龄28个月至16岁)和他们的父母/监护人(S)。HRQOL和心理功能采用经过良好验证的评估方法进行检查。依从性的测量包括临床就诊率和连续他克莫司血药浓度的标准差(SDS)，这些都是回顾性收集和评估的。衡量儿童健康状况的指标包括参与研究前一年的住院频率、肝脏活检、排斥反应和移植物功能。结果表明，不坚持与较低的身体HRQOL、较多限制与情绪和行为问题有关的社交和学校活动、父母情绪困扰和家庭凝聚力降低有关。不依从性也与住院次数和持续时间、肝活检和排斥反应有关。这些结果表明，基于经验的对HRQOL、育儿压力和家庭功能的评估可能有助于识别存在不遵守的风险的患者，并可能允许根据需要提供适当的临床干预。
The present study empirically assessed the relationships between adherence behaviors and HRQOL, parent and child psychological functioning and family functioning, and investigated the relationship between adherence behaviors and health outcomes in children who were within 5 years of their liver transplantation. Participants included 38 children (mean = 8.5 years, range 28 months to 16 years) and their parent/guardian(s). HRQOL and psychological functioning were examined using well-validated assessment measures. Measures of adherence included the rate of clinic attendance and standard deviations (SDs) of consecutive tacrolimus blood levels, which were collected and evaluated retrospectively. Measures of child health status included the frequency of hospital admissions, liver biopsies, episodes of rejection and graft function for the year prior to study participation. Results indicated that nonadherence was related to lower physical HRQOL, more limitations in social and school activities related to emotional and behavioral problems, parental emotional distress and decreased family cohesion. Nonadherence was also related to frequency and duration of hospitalizations, liver biopsies and rejection episodes. These results suggest that empirically based assessment of HRQOL, parenting stress and family functioning may help identify patients at risk for nonadherence, and may allow for the need-based delivery of appropriate clinical interventions.