***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT Rates of  obesity  and other childhood chronic conditions  have increased over recent decades . Patterns of how conditions change over time have not been widely examined . OBJECTIVE To evaluate change in prevalence of obesity and other chronic conditions  in US children , including incidence , remission , and prevalence . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve study using the National Longitudinal Survey of Youth-Child Cohort ( 1988 - 2006 ) of 3 nationally representative cohorts of children . Children were aged 2 through 8 years at the beginning of each study period , and cohorts were followed up for 6 years , from 1988 to 1994 ( cohort 1 , n = 2337 ) , 1994 to 2000 ( cohort 2 , n = 1759 ) , and 2000 to 2006 ( n = 905 ) . MAIN OUTCOME MEASURES Parent report of a child having a health condition that limited activities or schooling or required medicine , special equipment , or specialized health services and that lasted at least 12 months . Obesity was defined as a body mass index at or above the 95th percentile for age . Chronic conditions were grouped into 4 categories : obesity , asthma , other physical conditions , and behavior/learning problems . RESULTS The end- study prevalence of any chronic health condition was 12.8 % ( 95 % confidence interval [ CI ] , 11.2%-14.5 % ) for cohort 1 in 1994 , 25.1 % ( 95 % CI , 22.7%-27.6 % ) for cohort 2 in 2000 , and 26.6 % ( 95 % CI , 23.5%-29.9 % ) for cohort 3 in 2006 . There was substantial turnover in chronic conditions : 7.4 % ( 95 % CI , 6.5%-8.3 % ) of participants in all cohorts had a chronic condition at the beginning of the study that persisted to the end , 9.3 % ( 95 % CI , 8.3%-10.3 % ) reported conditions at the beginning that resolved within 6 years , and 13.4 % ( 95 % CI , 12.3%-14.6 % ) had new conditions that arose during the 6-year study period . The prevalence of having a chronic condition during any part of the 6-year study period was highest for cohort 3 ( 51.5 % ; 95 % CI , 47.3%-55.0 % ) , and there were higher rates among male ( adjusted odds ratio [ AOR ] , 1.24 ; 95 % CI , 1.07 - 1.42 ) , Hispanic ( AOR , 1.36 ; 95 % CI , 1.11 - 1.67 ) , and black ( AOR , 1.60 ; 95 % CI , 1.35 - 1.90 ) youth . CONCLUSIONS Prevalence of chronic conditions among children and youth increased from 1988 to 2006 . However , presence of these conditions was dynamic over each 6-year cohort OBJECTIVE To report initial feasibility and outcome from a pilot study of a new three-session intervention for caregivers of children newly diagnosed with cancer , Surviving Cancer Competently Intervention Program-Newly Diagnosed ( SCCIP-ND ) . METHOD Nineteen families ( 38 caregivers ) were r and omly assigned to  SCCIP-ND  or treatment as usual subsequent to learning of their child 's illness . The study design included pre- and 2-month postintervention assessment s , with state anxiety and posttraumatic stress symptoms as outcomes . Feasibility was based on therapist feedback and supervision , program evaluations , and data from study -tracking procedures . RESULTS SCCIP-ND appears to be an acceptable intervention that can be used successfully with caregivers over the first few months after diagnosis . Recruitment and retention data document feasibility but also highlight challenges . Preliminary outcome data show changes in the desired direction [ e.g. , reduced anxiety and parental posttraumatic stress symptoms ( PTSS ) ] . CONCLUSIONS The pilot data are supportive of the value and challenges of developing evidence -based family interventions in pediatric psychology Low-income African American children have disproportionately higher asthma morbidity and mortality . Education alone may not address barriers to asthma management due to psychosocial stress . This study evaluated the efficacy of a home-based family intervention integrating asthma education and strategies to address stress using a community-based participatory research model . Children age 8 to 13 with poorly controlled asthma and their caregivers were recruited from an urban hospital and an asthma camp . Caregivers with elevated scores on a stress measure were enrolled . Forty-three families were r and omized to the 4- to 6-session Home Based Family Intervention ( HBFI ) or the single session of Enhanced Treatment as Usual ( ETAU ) . All families received an asthma action plan and dust mite covers ; children performed spirometry and demonstrated MDI/spacer technique at each home visit . The HBFI addressed family-selected goals targeting asthma management and stressors . Asthma management , morbidity , family functioning , and caregiver stress were assessed at baseline , postintervention , and 6 months after the intervention . ED visits and hospitalizations were ascertained by medical record review for a year after intervention completion . Only one child ( 5 % ) in HBFI had an asthma-related hospitalization compared to 7 patients ( 35 % ) in ETAU in the year following intervention . Participants in both groups demonstrated improved asthma management and family functioning , and reduced ED visits , symptom days , missed school days , and caregiver stress , but there were no differential treatment effects . The results suggest that a home-based intervention addressing medical and psychosocial needs may prevent hospitalizations for children with poorly controlled asthma and caregivers under stress OBJECTIVE To compare glycemic control , body mass index ( BMI ) , neurocognitive function , and parenting stress for preschool-aged diabetic children r and omized to treatment either with continuous subcutaneous insulin infusion ( CSII ) or with intensive insulin injection therapy ( IIT ) . METHODS Children < 5 yr of age diagnosed with type 1 diabetes mellitus for at least 12 months were r and omized to either CSII ( n = 21 ) or IIT ( n = 21 ) for 6 months . After 6 months , the IIT group began CSII therapy and the CSII group continued on pumps . Hemoglobin A1c ( HbA1c ) and BMI percent were collected at baseline , 3 , 6 , 9 , and 12 months . Neurocognitive assessment s ( Developmental Test of Visual-Motor Integration and Stanford-Binet Intelligence Scale : Fourth Edition ) were administered to children , and parenting and child behavior assessment s ( Parenting Stress Index and Child Behavior Checklist ) were completed by parents and at baseline , 6 , and 12 months . RESULTS Thirty-five children completed the study .  Mean HbA1c decreased significantly over the study period ( 8.9 % + /- 0.6 vs. 8.5 % + /- 0.7 , p = 0.006 ) . Initiation of CSII result ed in an HbA1c decrease of 0.4 % after 3 months ( p = 0.002 ) ; however , in the CSII first group , the HbA1c at 12 months was not significantly different from study start ( 8.8 % + /- 0.6 vs. 8.5 % + /- 0.6 ; p = 0.4 ) . There were no significant changes in BMI % , neurocognitive , parenting , and child behavior measures between groups . CONCLUSION Initiation of CSII vs. continuing IIT does not significantly influence HbA1c , BMI , neurocognitive , or parenting stress parameters in a research study setting Risk- and -resistance models identify factors that predict psychosocial adjustment to pediatric chronic illness , including sickle cell disease ( SCD ) , but have not been applied to underst and health outcomes . The study objectives were to examine prospect ively the relationship of coping and family functioning with health outcomes for adolescents with SCD , accounting for sociodemographic and psychosocial risk . Forty-one adolescents and their families ( 41 primary caregivers , 9 second caregivers , and 15 healthy siblings ) completed paper- and -pencil measures of coping and family functioning at a baseline assessment ( time 1 ) . At both time 1 and time 2 ( 1 y later ) , disease severity , SCD complications , healthcare utilization , and average hemoglobin level were derived from medical file review s. Time 1 disease-related parenting stress predicted time 2 health outcomes ; however , there were no significant associations for coping . Families concordant in reporting lower family functioning had teens with increased disease severity and greater healthcare utilization . Examination of moderation of disease-related parenting stress by a risk index showed main effects for risk and for disease-related parenting stress for time 2 disease severity and time 2 healthcare utilization . Interaction effects were not significant . Efforts to explore specific mechanisms by which adaptive family functioning contributes to health outcomes for adolescents with SCD should continue , with particular attention to addressing the potential role of multiple sociodemographic and psychosocial risk variables The ketogenic diet is increasingly used for the management of difficult-to-control seizures in children . Here , we describe the first prospect i ve study of the effects of the diet on development , behavior , and parenting stress . Participants were 65 children ( 36 males , 29 females ) with intractable seizures , ages 18 months to 14 years 6 months , enrolled in a prospect i ve study at the Johns Hopkins Hospital , Baltimore , MD , USA , to study the diet 's efficacy . Children were assessed before diet initiation and at 1-year follow-up . At follow-up , 52 % ( 34 of 65 ) children remained on the diet . Mean seizure frequency decreased from 25 per day before diet initiation to less than two per day 1 year later . At follow-up , mean developmental quotient showed statistically significant improvement ( p<0.05 ) , with significant behavioral improvements in attention and social functioning . Parental stress was essentially unchanged . No baseline factor examined predicted diet adherence , and the primary reason for diet discontinuation was insufficient seizure control . These preliminary results support prior anecdotal reports of the beneficial effects of the diet on cognition and behavior BACKGROUND Hypoglycemia in preschool children limits the effectiveness of insulin therapy . Continuous subcutaneous insulin infusion ( CSII ) is not widely used in this group . OBJECTIVES This study was design ed ( 1 ) to test the hypothesis that compared with twice-daily insulin injection , CSII decreases the SD of the mean daily blood glucose ( BG ) and improves glycemic control and ( 2 ) to evaluate the effect of CSII on parental anxiety using the Parental Stress Index ( PSI ) scale . METHODS Ten subjects < 6 years of age and receiving insulin injections were recruited . Each underwent two 72-h CGMS ( Medtronic Minimed , Northridge , CA ) monitoring periods and then was started on CSII and re-monitored 3 and 6 months later . We assessed the effects of CSII on the mean BG and SD of BG values , A1c , PSI scores , and number , distribution , and duration of hypoglycemic episodes . RESULTS Pooled pre- and post-CSII data were compared . There was a 22 % decrease in the BG variability ( mean + /- SD 93 + /- 19 mg/dL vs. 72 + /- 5 mg/dL ; P = 0.02 ) and a 13 % decrease in A1c ( 8.6 + /- 0.8 % vs. 7.5 + /- 0.7 % ; P = 0.01 ) . There was a decrease in the 24-h median number and duration of hypoglycemic episodes [ 1.16 vs. 0 episodes/24 h ( P = 0.01 ) and 1.19 vs. 0.05 h/24 h ( P = 0.01 ) , respectively ] , as well as the median number and duration of nighttime episodes [ 0.83 vs. 0 episode/night ( P = 0.008 ) and 0.98 vs. 0 h/night ( P = 0.008 ) , respectively ] . We found no statistically significant change in the PSI score . CONCLUSIONS CSII in preschool children is feasible and safe .  Pump therapy reduced the glycemic excursions and decreased hypoglycemia duration and frequency In a prospect i ve study of 137 children ( 47 with cystic fibrosis , 48 with congenital heart disease , 42 with no chronic illness ) , four domains were examined as predictors of parent-reported behavioral problems , particularly internalizing problems , at 4 years of age : child health ,  child temperament , parent-child relationships  , and  family environment . Family environment , as measured by the  Parenting Stress Index  at 1 , 2 , and 3 years , was the most powerful predictor . This suggests that this index is useful as an early screen for children at risk for behavioral problems and that a reduction of parenting stress is an appropriate target of preventive interventions . J Dev Behav Pediatr 18:304 - 313 , 1997 
    Output:
    
Qualitative analysis revealed that greater general parenting stress was associated with greater parental responsibility for treatment management and was unrelated to illness duration and severity across illness population s. Greater parenting stress was associated with poorer psychological adjustment in caregivers and children with chronic illness .