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Wong JJ, Hanes SJ, Flores H, Ngo J, Hood KK. Satisfaction with diabetes involvement: Exploring parent and adolescent perspectives. Diabet Med 2024; 41:e15254. [PMID: 38010056 PMCID: PMC11021166 DOI: 10.1111/dme.15254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/13/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
AIMS Both parent and adolescent involvement in type 1 diabetes management are critical during adolescence. The current study sought to understand the factors associated with parent and adolescent satisfaction with their own and one another's involvement in diabetes management. METHODS Cross-sectional baseline data from 157 parent-adolescent dyads enrolled in an RCT were used. Adolescent ages ranged from 12 to 19 (Mage = 14.7, SD = 1.89) and were balanced by gender (50.3% male). Paired t-tests examined concordance between parent and adolescent satisfaction, bivariate correlations identified correlates, and regressions examined unique associations. RESULTS Roughly, 43% of adolescents and 29% of parents were very satisfied with adolescent involvement in diabetes management, whereas 71% of adolescents and 26.1% of parents were very satisfied with parent involvement. Indicators of better glycaemic health (via higher percent time-in-range and lower HbA1c and percent time in hyperglycaemia) and psychosocial functioning (less diabetes distress and depression) were correlated with higher satisfaction. Parent satisfaction with adolescent involvement was higher among older adolescents (R = 0.198, p = 0.013). Non-Hispanic white youth were more satisfied with their own involvement than youth of colour (t(149) = -2.783, p = 0.003). Both percent time-in-range and one's own diabetes distress uniquely related to parent and adolescent satisfaction with adolescent involvement. Conversely, parent satisfaction with their own involvement was only uniquely associated with parent diabetes distress. CONCLUSION Both adolescent and parents' satisfaction with adolescents' involvement in self-management are indicators of both glycaemic control and psychosocial well-being, whereas parents' self-evaluations are more closely tied to diabetes-specific distress.
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Affiliation(s)
- Jessie J Wong
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, California, USA
| | - Sarah J Hanes
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, California, USA
| | - Haley Flores
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, California, USA
| | - Jessica Ngo
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, California, USA
| | - Korey K Hood
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford, California, USA
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2
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Ip EJ, Doroudgar S, Salehi A, Salehi F, Najmi M. Diabulimia: A Risky Trend Among Adults with Type 1 Diabetes Mellitus. Endocr Pract 2023; 29:849-854. [PMID: 37567472 DOI: 10.1016/j.eprac.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVE Poor adherence leads to worse glycemic control and increased complications in patients with type 1 diabetes mellitus (T1DM). Diabulimia characterizes patients with T1DM who skip or use less insulin for weight loss purposes. The study objectives were to determine: (1) the prevalence of diabulimia among adult patients with T1DM, (2) compare patients with and without diabulimia, and (3) identify factors that may place individuals at higher risk of diabulimia. METHODS A 40-item, web-based survey was administered to 21 T1DM discussion boards, Listservs, and social media outlets. The survey assessed demographics, diabetes management, psychiatric diagnoses, and screened for diabulimia. Individuals who reported intentionally skipping or using less insulin than directed for the purpose of weight loss or to prevent weight gain in the past 12 months were classified as having diabulimia. RESULTS Of the 225 participants who completed the survey, 8.9% had diabulimia. Patients with diabulimia had elevated hemoglobin A1C (A1C) levels (8.4% vs 6.9%; P = .014), higher rates of a diabetes-related emergency department visits or hospitalization (30.0% vs 13.2%; P = .042), and higher rates of a major depressive disorder diagnosis (40.0% vs 11.5%; P < .001) than patients without diabulimia. Factors associated with diabulimia included high A1C levels (odds ratio, 1.43; 95% CI [1.08-1.91]; P = .014) and a major depressive disorder diagnosis (odds ratio, 4.87; 95% CI [1.31-18.22]; P = .018). CONCLUSION Approximately 1 in 11 adult patients with T1DM screened positive for diabulimia. Higher A1C levels and a diagnosis of major depressive disorder were associated with diabulimia.
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Affiliation(s)
- Eric J Ip
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California; Department of Internal Medicine, Kaiser Permanente Mountain View Medical Offices, Mountain View, California
| | - Shadi Doroudgar
- Department of Clinical Sciences, Touro University California College of Pharmacy, Vallejo, California
| | - Aava Salehi
- Department of Clinical Sciences, Touro University California College of Pharmacy, Vallejo, California
| | - Fojan Salehi
- Department of Internal Medicine, Kaiser Permanente Mountain View Medical Offices, Mountain View, California
| | - Mitra Najmi
- Department of Clinical Sciences, Touro University California College of Pharmacy, Vallejo, California.
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Schmidt M, Lu J, Luo W, Cheng L, Lee M, Huang R, Weng Y, Kichler JC, Corathers SD, Jacobsen LM, Albanese-O′Neill A, Smith L, Westen S, Gutierrez-Colina AM, Heckaman L, Wetter SE, Driscoll KA, Modi A. Learning experience design of an mHealth self-management intervention for adolescents with type 1 diabetes. EDUCATIONAL TECHNOLOGY RESEARCH AND DEVELOPMENT : ETR & D 2022; 70:2171-2209. [PMID: 36278247 PMCID: PMC9580427 DOI: 10.1007/s11423-022-10160-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
Type 1 diabetes (T1D) is a lifelong and chronic condition that can cause severely compromised health. The T1D treatment regimen is complex, and is a particular challenge for adolescents, who frequently experience a number of treatment adherence barriers (e.g., forgetfulness, planning and organizational challenges, stress). Diabetes Journey is a gamified mHealth program designed to improve T1D self-management through a specific focus on decreasing adherence barriers and improving executive functioning skills for adolescents. Grounded in situativity theory and guided by a sociotechnical-pedagogical usability framework, Diabetes Journey was designed, developed, and evaluated using a learning experience design approach. This approach applied design thinking methods within a Successive Approximation Model design process. Iterative design and formative evaluation were conducted across three design phases, and improvements were implemented following each phase. Findings from the user testing phase indicate Diabetes Journey is a user-friendly mHealth program with high usability that holds promise for enhancing adolescents' T1D self-management. Implications for future designers and researchers are discussed regarding the social dimension of the sociotechnical-pedagogical usability framework. An extension to the framework is proposed to extend the social dimension to include socio-cultural and contextual considerations when designing mHealth applications. Consideration of the pedagogical and sociocultural dimensions of learning is imperative when developing psychoeducational interventions.
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Affiliation(s)
- Matthew Schmidt
- College of Education, University of Florida, 2423 Norman Hall, PO BOX 117048, Gainesville, FL 32611 USA
| | - Jie Lu
- College of Education, University of Florida, 2423 Norman Hall, PO BOX 117048, Gainesville, FL 32611 USA
| | - Wenjing Luo
- College of Education, University of Florida, 2423 Norman Hall, PO BOX 117048, Gainesville, FL 32611 USA
| | - Li Cheng
- Worcester Polytechnic Institute, Worcester, USA
| | - Minyoung Lee
- College of Education, University of Florida, 2423 Norman Hall, PO BOX 117048, Gainesville, FL 32611 USA
| | - Rui Huang
- College of Education, University of Florida, 2423 Norman Hall, PO BOX 117048, Gainesville, FL 32611 USA
| | - Yueqi Weng
- College of Education, Purdue University, West Lafayette, USA
| | | | - Sarah D. Corathers
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, USA
| | | | | | - Laura Smith
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, USA
| | - Sarah Westen
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, USA
| | | | - Leah Heckaman
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, USA
| | - Sara E. Wetter
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, USA
| | - Kimberly A. Driscoll
- University of Florida Diabetes Institute, Gainesville, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, USA
| | - Avani Modi
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, USA
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4
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Khadilkar A, Oza C. Glycaemic Control in Youth and Young Adults: Challenges and Solutions. Diabetes Metab Syndr Obes 2022; 15:121-129. [PMID: 35046683 PMCID: PMC8759988 DOI: 10.2147/dmso.s304347] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/22/2021] [Indexed: 04/20/2023] Open
Abstract
Diabetes is the third most prevalent severe chronic disease of youth. Management of any chronic condition like type-1 diabetes (T1D) during adolescence, a time of rapid growth and physiological changes accompanied by important individuation and socialization processes, constitutes a major challenge for the youth, their family and the health-care team. The increasing prevalence of T1D in the adolescent age group and deteriorating glycaemic control from childhood to adolescence and youth, as well as the secular trend of worsening glycaemic control in youth and young adults with T1D, are a matter of real concern. Lack of monitoring, insufficient self-control, psychosocial factors, lack of family support and parental supervision, inadequate adherence to treatment, pubertal increase in insulin resistance and incompetent transition from paediatric to adult care are likely causes of deteriorating glycaemic control in youth. Efforts to improve insulin sensitivity by using pharmacological agents such as metformin are insufficient in resolving this problem. Interventions such as structured intervention, motivational interviews, development of youth friendly services and organization of diabetes camps for peer support can improve adherence in these individuals. Innovative technologies such as continuous subcutaneous insulin infusion and continuous glucose monitoring, comprehensive multidisciplinary teams with effective communication, parental support and supervision with planned transition from paediatric to adult care will not only reduce the risk of micro- and macrovascular complications in young adults with T1D but will also cause significant improvement in their quality of life.
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Affiliation(s)
- Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, 411 001, India
- Correspondence: Anuradha Khadilkar Hirabai Cowasji Jehangir Medical Research Institute, Block V Lower Basement Jehangir Hospital, 32 Sassoon Road, Pune, 411001, IndiaTel +91 206057004 Email
| | - Chirantap Oza
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, 411 001, India
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5
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Adolfsson P, Björnsson V, Hartvig NV, Kaas A, Møller JB, Ogionwo Lange E. Improved Glycemic Control Observed in Children with Type 1 Diabetes Following the Introduction of Smart Insulin Pens: A Real-World Study. Diabetes Ther 2022; 13:43-56. [PMID: 34748170 PMCID: PMC8776949 DOI: 10.1007/s13300-021-01177-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/20/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Many challenges are associated with optimizing glycemic control in pediatric patients with type 1 diabetes (T1D); combining data from smart insulin pens and continuous glucose monitoring (CGM) could mitigate some of these obstacles. METHODS This one-arm, prospective, observational study investigated the effects of introducing a smart pen on glycemic control in pediatric patients with T1D who were using CGM. Children and adolescents with T1D who had been prescribed a smart pen for basal and/or bolus insulin injections were enrolled from three clinics in Sweden. Outcomes compared between baseline and follow-up (≥ 12 months) included: mean numbers of daily (over 24 h) and nocturnal hypoglycemic or hyperglycemic events; time above range (TAR; > 180 mg/dL); time below range (TBR; level 1: 54 to < 70 mg/dL; level 2: < 54 mg/dL); time in range (TIR; 70-180 mg/dL); and missed bolus-dose (MBD) meals. RESULTS Overall, 39 patients were included. Mean numbers of daily hypoglycemic events (- 31.4%; p = 0.00035) and nocturnal hypoglycemic events (- 24.4%; p = 0.043) were significantly reduced from baseline to follow-up. Mean daily TBR level 2 was reduced from 2.82% at baseline to 2.18% at follow-up (- 0.64 percentage points; p = 0.025). There were no statistically significant changes in number of daily hyperglycemic events, MBD meals, TIR, TAR, or TBR level 1. CONCLUSIONS Introducing smart insulin pens was associated with a reduced number of hypoglycemic events and decreases in TBR level 2, demonstrating a potential benefit for glycemic control in pediatric patients.
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Affiliation(s)
- Peter Adolfsson
- Department of Pediatrics, The Hospital of Halland, Kungsbacka, Tölövägen 5, 43480, Kungsbacka, Sweden.
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Viktor Björnsson
- Department of Pediatrics, The Hospital of Halland, Kungsbacka, Tölövägen 5, 43480, Kungsbacka, Sweden
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Anne Kaas
- Medical & Science, Novo Nordisk A/S, Søborg, Denmark
| | | | - Elsa Ogionwo Lange
- Department of Pediatrics, The Hospital of Halland, Kungsbacka, Tölövägen 5, 43480, Kungsbacka, Sweden
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Ganesan K, Shakoor S, Wertz J, Agnew-Blais J, Bowes L, Jaffee SR, Matthews T, Arseneault L. Bullying behaviours and other conduct problems: longitudinal investigation of their independent associations with risk factors and later outcomes. Soc Psychiatry Psychiatr Epidemiol 2021; 56:2041-2052. [PMID: 33856493 PMCID: PMC8521530 DOI: 10.1007/s00127-021-02062-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 03/10/2021] [Indexed: 12/02/2022]
Abstract
PURPOSE Bullying behaviours and other conduct problems often co-occur. However, we do not yet know whether bullying behaviours are associated with early factors and later poor outcomes independently of conduct problems. While there are differing, specific interventions for bullying behaviours and for conduct problems, it is unclear if such specificity is justified given parallels between both behaviours. METHODS We used prospective data from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally representative sample of 2232 children. Mothers and teachers reported on children's bullying behaviours and conduct problems at ages 7 and 10. We collected measures of risk factors, including temperament and family factors, when children were age 5. We assessed behavioural, emotional, educational and social problems when participants reached the ages of 12 and 18. RESULTS Bullying behaviours and conduct problems co-occurred in childhood. Our findings indicated that bullying behaviours and other conduct problems were independently associated with the same risk factors. Furthermore, they were associated with the same poor outcomes at both ages 12 and 18. Despite this, bullying behaviours were uniquely associated with behavioural, emotional, educational and social problems at age 18. CONCLUSIONS Our findings suggest that anti-bullying programmes and interventions aimed at reducing conduct problems could benefit from greater integration. Furthermore, our study highlights the mental health problems children who bully may face in later years and the need to consider those in intervention plans.
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Affiliation(s)
- Keertana Ganesan
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Sania Shakoor
- Centre for Psychiatry, Wolfson Institute of Preventative Medicine, Queen Mary, University of London, London, UK
| | - Jasmin Wertz
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Jessica Agnew-Blais
- Social, Genetic, and Developmental Psychiatry Research Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Lucy Bowes
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Sara R Jaffee
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Timothy Matthews
- Social, Genetic, and Developmental Psychiatry Research Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Louise Arseneault
- Social, Genetic, and Developmental Psychiatry Research Centre, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
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7
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Stromberg SE, Boone DM, Healy A, Feldman M, Grishman EK, Faith MA. Social self-efficacy associated with HbA1c through physical activity and diabetes quality of life: A serial mediation study. Pediatr Diabetes 2021; 22:1081-1091. [PMID: 34455658 DOI: 10.1111/pedi.13261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/06/2021] [Accepted: 08/16/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Type 1 diabetes (T1D) is one of the most common pediatric chronic illnesses and increasing worldwide in prevalence. Physical activity has been positively linked with better glycemic control in youth with T1D. Although not yet studied, children's social self-efficacy may be a parameter related to physical activity in youth with diabetes. The current study investigated associations among social self-efficacy, physical activity, diabetes quality of life, and hemoglobin A1c (HbA1c) among youth with T1D utilizing mediation and serial mediation models. RESEARCH DESIGN AND METHODS Participants were 144 youth (M age = 14.95) with T1D (53.5% girls) and their caregivers. Youth completed the PedsQL Diabetes Module, the Physical Activity Questionnaire for Older Children and Adolescents and the Self-Efficacy Questionnaire for Social Skills for Children. Youths' HbA1c values were also measured. RESULTS Physical activity significantly mediated the relationship between greater youth social self-efficacy and better diabetes quality of life. Diabetes quality of life mediated the relationship between greater physical activity and lower HbA1c. The serial mediation model demonstrated greater social self-efficacy is related to greater physical activity, which in turn is related to better diabetes quality of life and ultimately resulting in lower HbA1c. CONCLUSIONS Physical activity, social self-efficacy, and diabetes-related quality of life may be modifiable factors related to HbA1c for youth with T1D. Findings indicate a need for healthcare providers to consider youth physical activity, quality of life, and social self-efficacy when evaluating and intervening in youth diabetes treatment adherence.
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Affiliation(s)
| | - Dianna M Boone
- Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Ashly Healy
- Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Marissa Feldman
- Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Ellen K Grishman
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Melissa A Faith
- Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
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8
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Zhou M, Bian B, Zhu W, Huang L. A Half Century of Research on Childhood and Adolescent Depression: Science Mapping the Literature, 1970 to 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9524. [PMID: 34574449 PMCID: PMC8465814 DOI: 10.3390/ijerph18189524] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 11/30/2022]
Abstract
In order to gain an in-depth understanding of research about childhood and adolescent depression, this article analyzes the scale, development, and geographic distribution of the literature in the field based on 8491 articles extracted from the Web of Science Core database. Using citation analysis, this article identifies influential journals, scholars, and documents in this field. The study found that in the past 15 years, the number of documents has increased significantly and geographical diversity has also increased. Most of the highly influential literature relates to depression inventories. Using keyword co-occurrence analysis, this article also identified three key research topics focusing on (a) child and adolescent depression symptoms and prevalence, (b) parental depression and child behavioral or emotional problems, and (c) childhood abuse and depression. This study uses 'science mapping' as a means to provide a better understanding of research trends about childhood and adolescent depression that have emerged over the past half century, and may serve as reference for future research.
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Affiliation(s)
| | | | | | - Li Huang
- College of Economics and Management, Shenyang Agricultural University, Shenyang 110866, Liaoning, China; (M.Z.); (B.B.); (W.Z.)
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9
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Fleischman K, Hains AA. Peer crowd affiliation, adherence, perceived support, and metabolic control in T1DM youth. J Child Health Care 2021; 25:240-252. [PMID: 32400166 DOI: 10.1177/1367493520924875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Youth with type 1 diabetes (T1DM) can face many challenges when adhering to their complex regimen in the context of their peer crowd. The aim of this study was to determine if peer crowd affiliation was associated with adolescents' adherence behaviors, perceived peer support, and metabolic control. A sample of 128 adolescents with T1DM completed the Peer Crowd Questionnaire, Diabetes Social Support Questionnaire-Friends Version, and Self-Care Inventory-Revised, and HbA1c readings were collected during their clinic visit. Results from this study suggest that adherence behaviors mediated the relationship between Jock peer crowd affiliation and metabolic control. Results also suggested that perceived peer support did not mediate the relationship between peer crowd affiliation and metabolic control through adherence behaviors. When examining the path coefficients for the purposed models, results showed a positive relationship between adherence and metabolic control, and more perceived peer support was related to worse metabolic control. Adolescents who identified mostly with the Jock peer crowd may hold lifestyle values that are consistent with the diabetes regimen which may make their diabetes management easier. In general, adolescents with T1DM may have a more multifaceted aspect of one's identity and therefore, their peer crowd affiliation is not as salient.
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Affiliation(s)
- Katie Fleischman
- Balance and Vestibular Program, Department of Otolaryngology, Boston Children's Hospital/Harvard Medical School, Waltham, MA, USA
| | - Anthony A Hains
- Department of Educational Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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10
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Giganti F, Gavazzi G, Righi S, Rossi A, Caprilli S, Giovannelli F, Toni S, Rebai M, Viggiano MP. Priming effect in children with Type 1 Diabetes Mellitus. Child Neuropsychol 2019; 26:100-112. [PMID: 31111792 DOI: 10.1080/09297049.2019.1617260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Previous studies have evidenced cognitive difficulties across various domains in Type 1 Diabetes Mellitus (T1DM) children, but the implicit memory system has not yet been systematically explored.Taking into account that the interplay between memory and perception may be modulated by the semantic category of the stimuli and their salience, we explored explicit and implicit memory using both object and food stimuli to verify whether for T1DM children there is a feebleness in performing the function of memory as a function of the stimuli used.Eighteen T1DM children and 47 healthy children performed an explicit recognition task in which they were requested to judge whether the presented image had already been shown ("old") or not ("new") and an identification priming task in which they were asked to name new and old pictures presented at nine ascending levels of spatial filtering.Results did not reveal any differences between controls and T1DM children in the explicit memory recognition task, whereas some differences between the two groups were found in the identification priming task. In T1DM children, the priming effect was observed only for food images.The dissociation between implicit and explicit memory observed in children with diabetes seems to be modulated by the category of the stimuli, and these results underscore the relevance of taking into account this variable when exploring cognitive functions.
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Affiliation(s)
- F Giganti
- Department of Neuroscience, Psychology, Drug Research, Child Health, University of Florence, Florence, Italy
| | - G Gavazzi
- Diagnostic and Nuclear Research Institute, IRCCS SDN, Napoli, Italy
| | - S Righi
- Department of Neuroscience, Psychology, Drug Research, Child Health, University of Florence, Florence, Italy
| | - A Rossi
- Department of Neuroscience, Psychology, Drug Research, Child Health, University of Florence, Florence, Italy
| | - S Caprilli
- Istituto di Psicoanalisi - ISIPSE, Rome, Italy
| | - F Giovannelli
- Department of Neuroscience, Psychology, Drug Research, Child Health, University of Florence, Florence, Italy
| | - S Toni
- Pediatric Diabetologic Unit, AOU Meyer, Florence, Italy
| | - M Rebai
- CRFDP, Normandie Université, Rouen, France
| | - M P Viggiano
- Department of Neuroscience, Psychology, Drug Research, Child Health, University of Florence, Florence, Italy
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Personality Functioning in Adolescents and Emerging Adults With Type 1 Diabetes. J Adolesc Health 2018; 63:792-798. [PMID: 30266568 DOI: 10.1016/j.jadohealth.2018.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 06/27/2018] [Accepted: 06/27/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE Although prior research has stressed the role of personality in adjusting to type 1 diabetes, longitudinal research is lacking. The objectives of the present study were twofold: (1) to chart the development of patients' personality over a 2-year period; and (2) to examine prospective associations among personality, treatment adherence, glycemic control, and diabetes-specific distress. METHODS Adolescents and emerging adults with type 1 diabetes, aged 14-25 years (Mage = 18.86 years, 54% female), participated in a three-wave longitudinal study spanning 2 years (n = 560 at Time 1). Patients filled out questionnaires on Big Five personality traits, treatment adherence, and diabetes-specific distress. HbA1c values were obtained from treating physicians. We used latent growth curve modeling to examine the development of patients' personality. Cross-lagged path analysis was performed to examine prospective associations among the study variables. RESULTS First, we observed mean-level increases in extraversion, agreeableness, and conscientiousness over the course of the study. Second, we uncovered bidirectional associations between personality and several important indicators of adjustment. Lower conscientiousness and higher extraversion predicted a relative decrease in treatment adherence 1 year later. Poorer treatment adherence, in turn, predicted relative decreases in conscientiousness and agreeableness over time. Furthermore, lower emotional stability predicted a relative increase in distress 1 year later. Higher distress, in turn, predicted a relative decrease in agreeableness over time. Finally, lower conscientiousness predicted poorer glycemic control 1 year later. CONCLUSIONS This study found young patients to move toward a more mature personality and stressed the importance of personality in adjusting to type 1 diabetes.
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12
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Katz LL, Anderson BJ, McKay SV, Izquierdo R, Casey TL, Higgins LA, Wauters A, Hirst K, Nadeau KJ. Correlates of Medication Adherence in the TODAY Cohort of Youth With Type 2 Diabetes. Diabetes Care 2016; 39:1956-1962. [PMID: 27352955 PMCID: PMC5079608 DOI: 10.2337/dc15-2296] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 05/01/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To identify factors that predict medication adherence and to examine relationships among adherence, glycemic control, and indices of insulin action in TODAY (Treatment Options for Type 2 Diabetes in Adolescents and Youth). RESEARCH DESIGN AND METHODS A total of 699 youth 10-17 years old with recent-onset type 2 diabetes and ≥80% adherence to metformin therapy for ≥8 weeks during a run-in period were randomized to receive one of three treatments. Participants took two study pills twice daily. Adherence was calculated by pill count from blister packs returned at visits. High adherence was defined as taking ≥80% of medication; low adherence was defined as taking <80% of medication. Depressive symptoms, insulin sensitivity (1/fasting insulin), insulinogenic index, and oral disposition index (oDI) were measured. Survival analysis examined the relationship between medication adherence and loss of glycemic control. Generalized linear mixed models analyzed trends in adherence over time. RESULTS In this low socioeconomic cohort, high and low adherence did not differ by sex, age, family income, parental education, or treatment group. Adherence declined over time (72% high adherence at 2 months, 56% adherence at 48 months, P < 0.0001). A greater percentage of participants with low adherence had clinically significant depressive symptoms at baseline (18% vs. 12%, P = 0.0415). No adherence threshold predicted the loss of glycemic control. Longitudinally, participants with high adherence had significantly greater insulin sensitivity and oDI than those with low adherence. CONCLUSIONS In the cohort, the presence of baseline clinically significant depressive symptoms was associated with subsequent lower adherence. Medication adherence was positively associated with insulin sensitivity and oDI, but, because of disease progression, adherence did not predict long-term treatment success.
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Affiliation(s)
- Lorraine Levitt Katz
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Barbara J Anderson
- Baylor College of Medicine, Houston, TX.,Texas Children's Hospital, Houston, TX
| | | | - Roberto Izquierdo
- State University of New York Upstate Medical University, Syracuse, NY
| | - Terri L Casey
- University Hospitals Case Medical Center, Cleveland, OH
| | - Laurie A Higgins
- Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, MA
| | - Aimee Wauters
- University of Texas Health Science Center, San Antonio, TX
| | - Kathryn Hirst
- George Washington University Biostatistics Center, Rockville, MD
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Carcone AI, Ellis DA, Chen X, Naar S, Cunningham PB, Moltz K. Multisystemic Therapy Improves the Patient-Provider Relationship in Families of Adolescents with Poorly Controlled Insulin Dependent Diabetes. J Clin Psychol Med Settings 2016; 22:169-78. [PMID: 25940767 DOI: 10.1007/s10880-015-9422-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to determine if multisystemic therapy (MST), an intensive, home and community-based family treatment, significantly improved patient-provider relationships in families where youth had chronic poor glycemic control. One hundred forty-six adolescents with type 1 or 2 diabetes in chronic poor glycemic control (HbA1c ≥8 %) and their primary caregivers were randomly assigned to MST or a telephone support condition. Caregiver perceptions of their relationship with the diabetes multidisciplinary medical team were assessed at baseline and treatment termination with the Measure of Process of Care-20. At treatment termination, MST families reported significant improvement on the Coordinated and Comprehensive Care scale and marginally significant improvement on the Respectful and Supportive Care scale. Improvements on the Enabling and Partnership and Providing Specific Information scales were not significant. Results suggest MST improves the ability of the families and the diabetes treatment providers to work together.
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Affiliation(s)
- April Idalski Carcone
- Prevention Research Center, Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA.
| | - Deborah A Ellis
- Prevention Research Center, Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xinguang Chen
- Department of Epidemiology, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Sylvie Naar
- Prevention Research Center, Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
| | - Phillippe B Cunningham
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Kathleen Moltz
- Division of Endocrinology, Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
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Schur HV, Gamsu DS, Barley VM. The Young Person's Perspective on Living and Coping with Diabetes. J Health Psychol 2016; 4:223-36. [DOI: 10.1177/135910539900400215] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Adolescence and young adulthood is a time of significant psychological and psychosocial development, and for young people with Type 1 diabetes mellitus it is a time when self-care and metabolic control of diabetes may become compromised. In order to enhance services’ efforts to meet the complex needs of young people with diabetes, a qualitative interview study with eight young people (aged 16–22 years) was carried out. Young people identified an inherent vulnerability associated with having diabetes and feared that diabetes would take control and overwhelm them. Through learning to live with diabetes, and learning to manage a relationship with diabetes, the young people had developed sophisticated, interrelated self-protective strategies to manage intrapersonal and interpersonal threats from diabetes.
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Affiliation(s)
| | - D. S. Gamsu
- Diabetes Centre, Northern General Hospital, Sheffield, UK
| | - Valerie M. Barley
- Oakwood Young People's Centre, Northern General Hospital, Sheffield, UK
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Abstract
Prevalence rates of childhood obesity have risen steeply over the last 3 decades. Given the increased national focus, the frequency of this clinical problem, and the multiple mental health factors that coexist with it, make obesity a public health concern. The complex relationships between mental health and obesity serve to potentiate the severity and interdependency of each. The purpose of this review is to create a contextual connection for the 2 conditions as outlined by the research literature and consider treatment options that affect both health problems.
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Affiliation(s)
- Leigh Small
- Family and Community Health Nursing Department, Virginia Commonwealth University School of Nursing, 1100 East Leigh Street, PO Box 980567, Richmond, VA 23298, USA.
| | - Alexis Aplasca
- Pediatrics and Psychiatry, Children's Hospital of Richmond/Virginia Treatment Center for Children, Virginia Commonwealth University School of Medicine, 515 North 10th Street, Richmond, VA 23298, USA
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16
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Goh CSY, Mohamed A, Lee YS, Loke KY, Wee HL, Khoo EYH, Griva K. The associations of self-care, illness perceptions and psychological distress with metabolic control in Singaporean adolescents with Type 1 Diabetes Mellitus. Health Psychol Behav Med 2016. [DOI: 10.1080/21642850.2015.1115728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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17
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Frequency of partial remission and related factors in children and adolescents diagnosed with type 1 diabetes mellitus. Int J Diabetes Dev Ctries 2015. [DOI: 10.1007/s13410-014-0230-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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18
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Eilander MMA, de Wit M, Rotteveel J, Aanstoot HJ, Waarde WMBV, Houdijk ECAM, Luman M, Nuboer R, Oosterlaan J, Winterdijk P, Snoek FJ. Diabetes IN develOpment (DINO): the bio-psychosocial, family functioning and parental well-being of youth with type 1 diabetes: a longitudinal cohort study design. BMC Pediatr 2015; 15:82. [PMID: 26173476 PMCID: PMC4502615 DOI: 10.1186/s12887-015-0400-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 07/02/2015] [Indexed: 02/08/2023] Open
Abstract
Background Strict glycemic control during adolescence decreases the risk of developing complications later in life, even if this level of control is not maintained afterwards. However, the majority of adolescents with type 1 diabetes (T1D) are in poor control and so far medical or psychological interventions have shown limited success. Adolescence is characterized by major biological, psychosocial, cognitive and parent–child relationship changes and the complex interaction between these developmental trajectories, and its impact on health outcomes is still poorly understood. A specific topic of interest in this context is the timing of diagnosis. The longitudinal study DINO (Diabetes IN develOpment) aims to examine:If and how the onset of T1D before vs. during puberty results in different outcomes of glycemic control, self-management, psychological functioning and diabetes-related quality of life. The timing of onset of disturbed eating behavior, its risk factors and its prospective course in relation to glycemic and psychological consequences. If and how the onset of T1D before vs. during puberty results in different family functioning and parental well-being. If and how the cognitive development of youth with T1D relates to glycemic control and diabetes self-management.
Methods/design DINO, a longitudinal multi-center cohort study is conducted in youth with T1D in the age range 8–15 years at baseline. Participants will be divided into two subgroups: pre-pubertal and pubertal. Both groups will be followed for 3 years with assessments based on a bio-psychosocial model of diabetes, scheduled at baseline, 12 months, 24 months and 36 months examining the biological, psychosocial -including disturbed eating behaviors- and cognitive development, family functioning and parental well-being. Discussion A better understanding of how the different trajectories affect one another will help to gain insight in the protective and risk factors for glycemic outcomes and in who needs which support at what moment in time. First results are expected in 2016. Electronic supplementary material The online version of this article (doi:10.1186/s12887-015-0400-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Minke M A Eilander
- Department of Medical Psychology, VU University Medical Center, De Boelenlaan 1117, 1081, HV, Amsterdam, The Netherlands. .,EMGO+Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands.
| | - Maartje de Wit
- Department of Medical Psychology, VU University Medical Center, De Boelenlaan 1117, 1081, HV, Amsterdam, The Netherlands. .,EMGO+Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands.
| | - Joost Rotteveel
- EMGO+Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands. .,Department of Pediatrics, VU Medical Center, De Boelelaan 1118, 1081, HV, Amsterdam, The Netherlands.
| | - Henk Jan Aanstoot
- Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Blaak 6, 3011, TA, Rotterdam, The Netherlands.
| | - Willie M Bakker-van Waarde
- Department Pediatrics, University Hospital of Groningen, Hanzeplein 1, 9700, RB, Groningen, The Netherlands.
| | - Euphemia C A M Houdijk
- Department of Pediatrics, Haga Hospital Juliana Children's Hospital, Sportlaan 600, 2566, MJ, the Hague, The Netherlands.
| | - Marjolein Luman
- Department Clinical Neuropsychology, Vrije Universiteit, Van der Boechorststraat 1, 1081, BT, Amsterdam, The Netherlands.
| | - Roos Nuboer
- Department of Pediatrics, Meander Medical Centre, Maatweg 3, 3813, TZ, Amersfoort, The Netherlands.
| | - Jaap Oosterlaan
- Department Clinical Neuropsychology, Vrije Universiteit, Van der Boechorststraat 1, 1081, BT, Amsterdam, The Netherlands.
| | - Per Winterdijk
- Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Blaak 6, 3011, TA, Rotterdam, The Netherlands.
| | - Frank J Snoek
- Department of Medical Psychology, VU University Medical Center, De Boelenlaan 1117, 1081, HV, Amsterdam, The Netherlands. .,EMGO+Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands. .,Department of Medical Psychology, Academic Medical Center (AMC), Meibergdreef 9, 1100, DD, Amsterdam, The Netherlands.
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19
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Balkhi AM, Reid AM, Westen SC, Olsen B, Janicke DM, Geffken GR. Telehealth interventions to reduce management complications in type 1 diabetes: A review. World J Diabetes 2015; 6:371-379. [PMID: 25897348 PMCID: PMC4398894 DOI: 10.4239/wjd.v6.i3.371] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 12/20/2014] [Accepted: 01/20/2015] [Indexed: 02/05/2023] Open
Abstract
Type 1 diabetes is a chronic illness with a high burden of care. While effective interventions and recommendations for diabetes care exist, the intensive nature of diabetes management makes compliance difficult. This is especially true in children and adolescents as they have unique psychosocial and diabetes needs. Despite the development of effective in-person interventions targeting improving self-management and ameliorating psychosocial difficulties there are still a number of barriers to implementing these interventions, namely time, cost, and access. Telehealth interventions allow for the dissemination of these interventions to a broader audience. Self-management and psychosocial telehealth interventions are reviewed with a special emphasis on mobile phone and internet based technology use. While efficacy has been demonstrated in a number of telehealth interventions with improved cost effectiveness over in-person interventions, many challenges remain including high participant attrition and difficulties with receiving reimbursement for services rendered. These and other challenges are discussed with recommendations for researchers and telehealth providers provided.
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20
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Baucom KJW, Queen TL, Wiebe DJ, Turner SL, Wolfe KL, Godbey EI, Fortenberry KT, Mansfield JH, Berg CA. Depressive symptoms, daily stress, and adherence in late adolescents with type 1 diabetes. Health Psychol 2015; 34:522-30. [PMID: 25798545 DOI: 10.1037/hea0000219] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine whether depressive symptoms are associated with greater perceived daily stress and moderate the link between stress severity and poorer daily adherence in late adolescents with Type 1 diabetes (T1D). METHOD 175 late adolescents with T1D completed measures of depressive symptoms and glycemic control during a baseline laboratory assessment. This assessment was followed by a 14-day daily diary during which adolescents rated the severity of general (GS) and diabetes-specific (DSS) stressful events, as well as adherence to their diabetes regimen. RESULTS Multilevel modeling revealed that adolescents with more depressive symptoms reported more severe daily stress and poorer daily adherence on average, and had poorer glycemic control. On days with more severe DSS, but not GS, adolescents reported poorer adherence. This association was moderated by an interaction between depressive symptoms and the mean level of DSS severity experienced across the 2-week diary. In adolescents with low levels of depressive symptoms, poorer adherence was reported on days with more severe DSS across all levels of mean DSS severity. In adolescents with average or high levels of depressive symptoms, poorer adherence was reported on days with more severe DSS only when mean DSS severity was average or high. CONCLUSIONS Depressive symptoms are associated with poorer daily adherence and greater stress severity, and interact with mean DSS severity to moderate the link between daily stress and adherence. The results point to the importance of depressive symptoms for understanding associations between stress and adherence during late adolescence.
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Affiliation(s)
| | | | - Deborah J Wiebe
- Department of Psychological Sciences, University of California, Merced
| | | | - Kristin L Wolfe
- Division of Psychology, Department of Psychiatry, University of Texas Southwestern Medical Center
| | - Elida I Godbey
- Division of Psychology, Department of Psychiatry, University of Texas Southwestern Medical Center
| | - Katherine T Fortenberry
- Division of Family Medicine, Department of Family and Preventive Medicine, University of Utah
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21
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Coffen RD. The 600-Step Program for Type 1 Diabetes Self-Management in Youth: The Magnitude of the Self-Management Task. Postgrad Med 2015; 121:119-39. [DOI: 10.3810/pgm.2009.09.2059] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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22
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Fritsch SL, Overton MW, Robbins DR. The interface of child mental health and juvenile diabetes mellitus. Psychiatr Clin North Am 2015; 38:59-76. [PMID: 25725569 DOI: 10.1016/j.psc.2014.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Diabetes mellitus is a common childhood illness, and its management is often complicated by mental health challenges. Psychiatric comorbidities are common, including anxiety, depression, and eating disorders. The illness can profoundly affect the developing brain and family functioning and have lifelong consequences. The child mental health provider can provide valuable assistance to support the child and family and assessment and treatment of comorbid mental health problems and to promote positive family functioning and normal developmental progress.
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Affiliation(s)
- Sandra L Fritsch
- Child and Adolescent Psychiatry, Maine Medical Center, Tufts University School of Medicine, 22 Bramhall Street, Portland, ME 04102, USA; Department of Psychiatry, Child & Adolescent Psychiatry Fellowship, Maine Medical Center, 22 Bramhall Street, Portland, ME 04102, USA.
| | | | - Douglas R Robbins
- Child and Adolescent Psychiatry, Maine Medical Center, Tufts University School of Medicine, 22 Bramhall Street, Portland, ME 04102, USA; Department of Psychiatry, The Glickman Family Center for Child & Adolescent Psychiatry, Maine Medical Center, 22 Bramhall Street, Portland, ME 04102, USA; Department of Psychiatry, Child & Adolescent Psychiatry, Maine Medical Center, 22 Bramhall Street, Portland, ME 04102, USA
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23
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Hosek SG, Harper GW, Domanico R. Psychological and Social Difficulties of Adolescents Living With HIV: A Qualitative Analysis. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/01614576.2000.11074360] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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24
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Merwin RM, Moskovich AA, Dmitrieva NO, Pieper CF, Honeycutt LK, Zucker NL, Surwit RS, Buhi L. Disinhibited eating and weight-related insulin mismanagement among individuals with type 1 diabetes. Appetite 2014; 81:123-30. [PMID: 24882448 PMCID: PMC4130344 DOI: 10.1016/j.appet.2014.05.028] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 05/18/2014] [Accepted: 05/23/2014] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Withholding insulin for weight control is a dangerous practice among individuals with type 1 diabetes; yet little is known about the factors associated with this behavior. Studies of nondiabetic individuals with weight concerns suggest that eating in a disinhibited manner (e.g., binge eating) predicts the use of maladaptive compensatory strategies (e.g., self-induced vomiting). The purpose of this study was to test whether individuals with type 1 diabetes are less restrained in their eating when they think their blood glucose (BG) is low and whether this contributes to insulin omission for weight control purposes and subsequently higher hemoglobin A1c (HbA1c). METHODS Two-hundred and seventy-six individuals with type 1 diabetes completed an online survey of eating behaviors, insulin dosing and most recent HbA1c. We used structural equation modeling to test the hypothesis that disinhibited eating when blood sugar is thought to be low predicts weight-related insulin mismanagement, and this, in turn, predicts higher HbA1c. RESULTS The majority of participants endorsed some degree of disinhibition when they think their blood glucose is low (e.g., eating foods they do not typically allow) and corresponding negative affect (e.g., guilt/shame). The frequency of disinhibited eating was positively associated with weight-related insulin mismanagement. Controlling for age, sex, education, and insulin pump use, the model explained 31.3% of the variance in weight-related insulin mismanagement and 16.8% of the variance in HbA1c. CONCLUSION Addressing antecedents to disinhibited eating that are unique to type 1 diabetes (e.g., perceived BG level) and associated guilt or shame may reduce weight-related insulin omission.
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Affiliation(s)
- Rhonda M Merwin
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, DUMC Box 3842, Durham, NC 27710.
| | - Ashley A Moskovich
- Duke University, Department of Psychology and Neuroscience, 417 Chapel Drive, Durham, NC 27708
| | - Natalia O Dmitrieva
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, DUMC Box 3842, Durham, NC 27710
| | - Carl F Pieper
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, DUMC Box 3842, Durham, NC 27710
| | - Lisa K Honeycutt
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, DUMC Box 3842, Durham, NC 27710
| | - Nancy L Zucker
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, DUMC Box 3842, Durham, NC 27710; Duke University, Department of Psychology and Neuroscience, 417 Chapel Drive, Durham, NC 27708
| | - Richard S Surwit
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, DUMC Box 3842, Durham, NC 27710; Duke University, Department of Psychology and Neuroscience, 417 Chapel Drive, Durham, NC 27708
| | - Lori Buhi
- Duke University, Department of Psychology and Neuroscience, 417 Chapel Drive, Durham, NC 27708
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25
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Affiliation(s)
| | - Mary S Burr
- University of Maryland School of Nursing, Baltimore, MD
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26
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Wu YP, Rausch J, Rohan JM, Hood KK, Pendley JS, Delamater A, Drotar D. Autonomy support and responsibility-sharing predict blood glucose monitoring frequency among youth with diabetes. Health Psychol 2014; 33:1224-31. [PMID: 24467252 DOI: 10.1037/hea0000034] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Adolescence poses a number of special challenges for youth and their families managing the Type 1 diabetes medical regimen. Little is known on how family and youth factors and management of the regimen change over the course of early adolescence and predict adherence to the regimen during this developmental period. METHODS Youth with Type 1 diabetes (n = 239) and their maternal caregivers completed measures of diabetes-specific autonomy support, diabetes-related family conflict, regimen responsibility, and blood glucose monitoring frequency (BGMF) at 4 timepoints over a 3-year period. RESULTS Autonomy support and BGMF significantly decreased over time and responsibility for the diabetes regimen shifted from the caregiver toward youth over time. Significant changes in perceived family conflict over time differed depending on the reporter. Baseline BGMF, changes in caregiver autonomy support, and changes in responsibility for the regimen significantly predicted changes in BGMF over time. CONCLUSIONS This study documents changes in autonomy support, youth responsibility for the diabetes regimen, and BGMF during the transition into early adolescence. Higher levels of caregiver autonomy support preserve BGMF during a developmental period in which BGMF typically deteriorates.
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Affiliation(s)
- Yelena P Wu
- Center for Treatment Adherence and Self-Management
| | - Joseph Rausch
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Jennifer M Rohan
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Korey K Hood
- Madison Clinic for Pediatric Diabetes, Division of Endocrinology, Department of Pediatrics, University of California
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Abstract
Increasing numbers of adolescents are being diagnosed with Crohn's disease or ulcerative colitis, the two main subtypes of inflammatory bowel disease. These young people face many short- and long-term challenges; one or more medical therapies may be required indefinitely; their disease may have great impact, in terms of their schooling and social activities. However, the management of adolescents with one of these incurable conditions needs to encompass more than just medical therapies. Growth, pubertal development, schooling, transition, adherence, and psychological well-being are all important aspects. A multidisciplinary team setting, catering to these components of care, is required to ensure optimal outcomes in adolescents with inflammatory bowel disease.
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Affiliation(s)
- J Bishop
- Paediatric Gastroenterology, Starship Children’s Hospital, Auckland, New Zealand
| | - DA Lemberg
- Department of Gastroenterology, Sydney Children’s Hospital, Sydney, Australia
| | - AS Day
- Department of Paediatrics, University of Otago (Christchurch), Christchurch, New Zealand
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28
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Maggio ABR, Saunders Gasser C, Gal-Duding C, Beghetti M, Martin XE, Farpour-Lambert NJ, Chamay-Weber C. BMI changes in children and adolescents attending a specialized childhood obesity center: a cohort study. BMC Pediatr 2013; 13:216. [PMID: 24369093 PMCID: PMC3877963 DOI: 10.1186/1471-2431-13-216] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 12/14/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Multidisciplinary group therapies for obese children and adolescents are effective but difficult to implement. There is a crucial need to evaluate simpler management programs that target the obese child and his family. This study aimed to determine changes in body mass indexes (BMI) after individual family-based obesity intervention with a pediatrician in a specialized obesity center for child and adolescent. METHODS This cohort study included 283 patients (3.3 to 17.1 years, mean 10.7 ± 2.9) attending the Pediatric Obesity Care Program of the Geneva University Hospitals. Medical history and development of anthropometric were assessed in consultations. Pediatricians used an integrative approach that included cognitive behavioral techniques (psycho-education, behavioral awareness, behavioral changes by small objectives and stimulus control) and motivational interviewing. Forty five children were also addressed to a psychologist. RESULTS Mean follow-up duration was 11.4 ± 9.8 months. The decrease in BMI z-score (mean: -0.18 ± 0.40; p < .001) was significant for 49.5% of them. It was dependent of age, BMI at baseline (better in youngest and higher BMI) and the total number of visits (p = .025). Additional psychological intervention was associated with reduced BMI z-score in children aged 8 to 11 years (p = .048). CONCLUSIONS Individual family obesity intervention induces a significant weight reduction in half of the children and adolescents, especially in the youngest and severely obese. This study emphasizes the need to encourage trained pediatricians to provide individual follow up to these children and their family. Our study also confirms the beneficial effect of a psychological intervention in selected cases.
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Affiliation(s)
- Albane B R Maggio
- Pediatric sport medicine and obesity care program, Division of pediatric specialties, Department of Child and Adolescent, University Hospitals of Geneva and University of Geneva, 6, rue Willy-Donzé, 1211, Geneva 14, Switzerland.
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Pinhas-Hamiel O, Hamiel U, Greenfield Y, Boyko V, Graph-Barel C, Rachmiel M, Lerner-Geva L, Reichman B. Detecting intentional insulin omission for weight loss in girls with type 1 diabetes mellitus. Int J Eat Disord 2013; 46:819-25. [PMID: 23674378 DOI: 10.1002/eat.22138] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 03/24/2013] [Accepted: 03/25/2013] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Intentional insulin omission is a unique inappropriate compensatory behavior that occurs in patients with type 1 diabetes mellitus, mostly in females, who omit or restrict their required insulin doses in order to lose weight. Diagnosis of this underlying disorder is difficult. We aimed to use clinical and laboratory criteria to create an algorithm to assist in the detection of intentional insulin omission. METHOD The distribution of HbA1c levels from 287 (181 females) patients with type 1 diabetes were used as reference. Data from 26 patients with type 1 diabetes and intentional insulin omission were analysed. The Weka (Waikato Environment for Knowledge Analysis) machine learning software, decision tree classifier with 10-fold cross validation was used to developed prediction models. Model performance was assessed by cross-validation in a further 43 patients. RESULTS Adolescents with intentional insulin omission were discriminated by: female sex, HbA1c>9.2%, more than 20% of HbA1c measurements above the 90th percentile, the mean of 3 highest delta HbA1c z-scores>1.28, current age and age at diagnosis. The models developed showed good discrimination (sensitivity and specificity 0.88 and 0.74, respectively). The external test dataset revealed good performance of the model with a sensitivity and specificity of 1.00 and 0.97, respectively. DISCUSSION Using data mining methods we developed a clinical prediction model to determine an individual's probability of intentionally omitting insulin. This model provides a decision support system for the detection of intentional insulin omission for weight loss in adolescent females with type 1 diabetes mellitus.
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Affiliation(s)
- Orit Pinhas-Hamiel
- Maccabi Health Care Services, Juvenile Diabetes Center, Raanana, Israel; Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Reid AM, Balkhi AM, St. Amant J, McNamara JPH, Silverstein JH, Navia L, Geffken G. Relations Between Quality of Life, Family Factors, Adherence, and Glycemic Control in Pediatric Patients With Type 1 Diabetes Mellitus. CHILDRENS HEALTH CARE 2013. [DOI: 10.1080/02739615.2013.842455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Hilliard ME, Rohan JM, Rausch JR, Delamater A, Pendley JS, Drotar D. Patterns and predictors of paternal involvement in early adolescents' type 1 diabetes management over 3 years. J Pediatr Psychol 2013; 39:74-83. [PMID: 24013966 DOI: 10.1093/jpepsy/jst067] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To document trajectories of paternal involvement in diabetes management and examine bidirectional associations with diabetes outcomes across early adolescence. METHODS 3-year prospective assessment of paternal involvement, diabetes self-management, and glycemic control among 136 youth (age 9-12 at baseline) and their mothers and fathers. RESULTS Unconditional growth curves demonstrated decreasing amount (maternal report: F(1,128) = 14.79; paternal report: F(1,111) = 12.95, ps < 0.01) and level of contribution (maternal report: F(1,131) = 23.6, p < .01) of paternal involvement. Controlling for covariates, lower youth self-management predicted an increasing slope in fathers' self-reported amount of involvement (b = -0.15 to -0.22, p < .05), and higher levels of fathers' self-reported level of contribution predicted a decreasing slope in youths' self-reported self-management (b = -0.01, p < .05). CONCLUSIONS Like mothers, fathers' involvement declines modestly during early adolescence. Different aspects of paternal involvement influence or are influenced by youths' self-management. Communication about ways to enhance fathers' involvement before this transition may help prevent or reduce declining diabetes management and control common in adolescence.
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Affiliation(s)
- Marisa E Hilliard
- PhD, Baylor College of Medicine/Texas Children's Hospital, 1102 Bates Street, Suite 940, Houston, TX 77030, USA.
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Hilliard ME, Wessendorf KA, Peugh JL, Hood KK. How poorer quality of life in adolescence predicts subsequent type 1 diabetes management and control. PATIENT EDUCATION AND COUNSELING 2013; 91:120-5. [PMID: 23182614 PMCID: PMC4467557 DOI: 10.1016/j.pec.2012.10.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 10/01/2012] [Accepted: 10/27/2012] [Indexed: 06/17/2023]
Abstract
OBJECTIVE Detriments in quality of life (QOL) may contribute to the common, costly decline in adolescents' type 1 diabetes management and control, yet we know little about how this might happen. METHODS Participants were 150 adolescents (age 13-18) with type 1 diabetes and their parents. We constructed a latent QOL variable from a multi-informant, multi-domain assessment when participants entered the study. The QOL variable was examined in relation to prospective assessments of diabetes management (blood glucose monitoring frequency; BGM) and control (hemoglobin A1c). We used an indirect path model to test the links among these variables, using bias-corrected bootstrapping. RESULTS Poorer QOL at baseline was indirectly linked with higher A1c at 12 months via less frequent BGM obtained at 6 months (b = -0.01, 95% CI = -0.025, -0.004, p < 0.05). Older age (b = -0.32), longer diabetes duration (b = -0.07), and insulin delivery via injections versus the insulin pump (b = 0.67) were covariates of less frequent BGM, and unmarried caregiver status was associated with higher A1c (b = -0.76), all ps < 0.05. CONCLUSIONS In this study, poorer QOL acted as a barrier to effective diabetes management, subsequently altering diabetes control. PRACTICE IMPLICATIONS Efforts to monitor and enhance QOL may hold promise for improving adolescents' diabetes outcomes in the future.
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Affiliation(s)
- Marisa E Hilliard
- Johns Hopkins Adherence Research Center, Johns Hopkins School of Medicine, Department of Medicine, 5501 Hopkins Bayview Circle, JHAAC 3B.24, Baltimore, MD, USA 21224
| | - Krista A Wessendorf
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - James L Peugh
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Korey K Hood
- University of California San Francisco, Division of Endocrinology, Department of Pediatrics, 400 Parnassus Avenue, 4 Floor, UCSF Mailbox 0318, San Francisco, CA, USA 94122-0318, Office: 415-514-8533; Fax: 513-803-0415,
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Abstract
OBJECTIVE To determine if 3 distinct self-management patterns (i.e., maladaptive, moderate/mixed, and adaptive) observed at baseline, 1 year, and 2 years in a sample of youth with type 1 diabetes and their caregivers predicted mean differences in adolescent's subsequent glycemic control. METHODS This study is a descriptive, multisite, prospective study that examined a sample of youth diagnosed with type 1 diabetes (ages 9-11 years at baseline). Youth and their maternal and paternal caregivers provided information about the youth's self-management patterns at baseline, 1 year, and 2 years using the Diabetes Self-Management Profile structured interview. Glycemic control (hemoglobin A1c: HbA1c) was examined at baseline and 6, 12, 18, and 24 months. RESULTS Three distinct self-management patterns were observed at 1 year and 2 years, which were conceptually consistent with previously reported baseline self-management patterns. Youth identified by their maternal caregivers as having adaptive self-management patterns at baseline had better glycemic control across 2 years compared with those in the maladaptive and mixed self-management groups. Similarly, maternal reports suggested that youth with less adaptive self-management patterns generally had worse glycemic control over time and HbA1c values above the American Diabetes Association recommendations. Youth and paternal caregiver reports yielded more variable findings. CONCLUSIONS Findings underscore the stability of self-management patterns in pediatric type 1 diabetes and the need for preventive interventions that are tailored to specific patterns of self-management associated with risk for problematic glycemic control.
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Hilliard ME, Wu YP, Rausch J, Dolan LM, Hood KK. Predictors of deteriorations in diabetes management and control in adolescents with type 1 diabetes. J Adolesc Health 2013; 52:28-34. [PMID: 23260831 PMCID: PMC4467546 DOI: 10.1016/j.jadohealth.2012.05.009] [Citation(s) in RCA: 168] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 05/16/2012] [Accepted: 05/17/2012] [Indexed: 02/06/2023]
Abstract
PURPOSE Deteriorating type 1 diabetes management and control are common among adolescents; however, clinical evidence suggests that individual trajectories can vary. The aim of this study was to examine patterns and predictors of blood glucose monitoring (BGM) frequency and glycemic control (hemoglobin A1c). METHODS Prospective data analysis spanning 18-24 months was conducted with 150 adolescent-parent pairs. Latent group-based trajectory modeling identified subgroups and determined medical, demographic, psychological, and family predictors of subgroup membership. RESULTS Three subgroups emerged, representing diabetes management and control that are "meeting treatment targets" (40%; A1c at baseline = 7.4%, BGM frequency at baseline = 4.8 checks/day) and two levels "not meeting targets":"normatively similar" youth (40%; A1c = 9.2%, BGM frequency = 2.8 checks/day), and "high-risk" youth (20%; A1c = 11.2%, BGM frequency = 2.9 checks/day). Subgroup membership was maintained over 18-24 months. There was minimal change across time, although only one-third of adolescents met treatment targets. Older age, longer diabetes duration, ethnic minority status, unmarried caregiver status, insulin delivery via injections versus continuous subcutaneous insulin infusion, greater depressive symptoms, negative affect about BGM, and diabetes-specific family conflict each predicted membership in a subgroup with poorer diabetes management and control. CONCLUSIONS Among the nearly two-thirds of adolescents with management and control that do not meet treatment targets, modifiable and nonmodifiable factors may signal the need for prevention or intervention. Demographic and medical factors may call for proactive efforts to prevent deterioration, and psychological symptoms and family conflict signal opportunities for clinical intervention to promote improved diabetes management and control in adolescence.
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Affiliation(s)
- Marisa E. Hilliard
- Johns Hopkins Adherence Research Center, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yelena P. Wu
- Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Treatment Adherence and Self-Management, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Joseph Rausch
- Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Treatment Adherence and Self-Management, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Lawrence M. Dolan
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Korey K. Hood
- Division of Endocrinology, Department of Pediatrics, University of California San Francisco, San Francisco, CA
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Hilliard ME, Harris MA, Weissberg-Benchell J. Diabetes resilience: a model of risk and protection in type 1 diabetes. Curr Diab Rep 2012; 12:739-48. [PMID: 22956459 DOI: 10.1007/s11892-012-0314-3] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Declining diabetes management and control are common as children progress through adolescence, yet many youths with diabetes do remarkably well. Risk factors for poor diabetes outcomes are well-researched, but fewer data describe processes that lead to positive outcomes such as engaging in effective diabetes self-management, experiencing high quality of life, and achieving in-range glycemic control. Resilience theory posits that protective processes buffer the impact of risk factors on an individual's development and functioning. We review recent conceptualizations of resilience theory in the context of type 1 diabetes management and control and present a theoretical model of pediatric diabetes resilience. Applications to clinical care and research include the development of preventive interventions to build or strengthen protective skills and processes related to diabetes and its management. The ultimate goal is to equip youths with diabetes and their families with the tools to promote both behavioral and health-related resilience in diabetes.
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Affiliation(s)
- Marisa E Hilliard
- Johns Hopkins Adherence Research Center, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, JHAAC 3B.24, Baltimore, MD 21224, USA.
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Rausch JR, Hood KK, Delamater A, Shroff Pendley J, Rohan JM, Reeves G, Dolan L, Drotar D. Changes in treatment adherence and glycemic control during the transition to adolescence in type 1 diabetes. Diabetes Care 2012; 35:1219-24. [PMID: 22474040 PMCID: PMC3357213 DOI: 10.2337/dc11-2163] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To test models of unidirectional and bidirectional change between treatment adherence and glycemic control in youth with type 1 diabetes. RESEARCH DESIGN AND METHODS We conducted a 2-year longitudinal, multisite study of 225 youth with type 1 diabetes recruited at the cusp of adolescence (aged 9-11 years) to describe the mutual influences of glycemic control as measured by HbA(1c) and treatment adherence as measured by blood glucose monitoring frequency (BGMF) during the transition to adolescence. RESULTS HbA(1c) increased from 8.2 to 8.6% (P < 0.001) and BGMF decreased from 4.9 to 4.5 checks per day (P < 0.02) during the 2-year period. Changes in the BGMF slope predicted changes in HbA(1c). A change (increase) in HbA(1c) was associated with a change (decrease) in BGMF of 1.26 (P < 0.001) after controlling for covariates. CONCLUSIONS The magnitude of the effect of declining treatment adherence (BGMF) on glycemic control in young adolescents may be even greater than declines observed among older adolescents. BGMF offers a powerful tool for targeted management of glycemic control for type 1 diabetes during the critical transition to adolescence.
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Affiliation(s)
- Joseph R Rausch
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
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Drotar D, Ittenbach R, Rohan JM, Gupta R, Pendley JS, Delamater A. Diabetes management and glycemic control in youth with type 1 diabetes: test of a predictive model. J Behav Med 2012; 36:234-45. [PMID: 22569775 DOI: 10.1007/s10865-012-9426-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 04/16/2012] [Indexed: 01/12/2023]
Abstract
The objective of this study was to test a comprehensive model of biologic (pubertal status), family (communication and conflict), and psychological influences (behavioral autonomy) on diabetes management and glycemic control in a sample of youth (N = 226) with type 1 diabetes recruited during late childhood/early adolescence (ages 9-11 years). The study design was a prospective, multisite, multi-method study involving prediction of diabetes management and glycemic control 1 year post-baseline. The primary outcome measures included diabetes management behaviors based on the Diabetes Self-Management Profile (DSMP) administered separately to mothers and youth and glycemic control measured by glycated hemoglobin (HbA1c) obtained by blood samples and analyzed by a central laboratory to ensure standardization. Our hypothesized predictive model received partial support based on structural equation modeling analyses. Family conflict predicted less adequate glycemic control 1 year later (p < 0.05). Higher conflict predicted less adequate diabetes management and less adequate glycemic control. More advanced pubertal status also predicted less adequate glycemic control, but behavioral autonomy did not. Family conflict is an important, potentially clinically significant influence on glycemic control that should be considered in primary and secondary prevention in the management of type 1 diabetes in youth.
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Affiliation(s)
- Dennis Drotar
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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Fortenberry KT, Wiebe DJ, Berg CA. Perceptions of treatment control moderate the daily association between negative affect and diabetes problems among adolescents with type 1 diabetes. Psychol Health 2012; 27:294-309. [DOI: 10.1080/08870446.2011.561925] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Helgeson VS, Palladino DK. Agentic and communal traits and health: adolescents with and without diabetes. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2011; 38:415-28. [PMID: 22146673 DOI: 10.1177/0146167211427149] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors examined whether agentic and communal traits are associated with relationship and health outcomes among adolescents with and without diabetes. They interviewed 263 teens (average age 12; 132 Type 1 diabetes; 131 healthy) on an annual basis for 5 years. The authors measured agency, communion, unmitigated agency, and unmitigated communion as well as parent and peer relationship quality, psychological distress, and diabetes health. In concurrent and lagged multilevel models, unmitigated communion and unmitigated agency were associated with poor relationship outcomes and greater psychological distress for those with and without diabetes. In lagged analyses, unmitigated communion predicted deterioration in diabetes health. Communion and agency were associated with positive relationship and health outcomes, with the former being stronger than the latter. These results underscore the need to focus on unmitigated agency and unmitigated communion when studying the implications of personality for health during adolescence.
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Affiliation(s)
- Vicki S Helgeson
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA.
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Baker JR, Riske B, Voutsis M, Cutter S, Presley R. Insurance, home therapy, and prophylaxis in U.S. youth with severe hemophilia. Am J Prev Med 2011; 41:S338-45. [PMID: 22099356 DOI: 10.1016/j.amepre.2011.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 08/19/2011] [Accepted: 09/06/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Home infusion therapy, particularly on a prophylactic regimen, is linked with reduced morbidity among youth with severe hemophilia. However, the association of insurance coverage with these home therapies is unknown. PURPOSE This study explores the connections among insurance, home infusion therapy, and prophylaxis treatment in a nationwide cohort of 3380 boys and young men (aged 2 to 20 years) with severe hemophilia. These youth obtained care at one of 129 federally supported hemophilia treatment centers (HTCs), and enrolled in the CDC's bleeding disorder surveillance project. METHODS Multiple regression was used to analyze the independent association among risk factors, including insurance, and both home infusion and prophylaxis. Data were obtained between January 1, 2008, and December 31, 2010, and analyzed in 2011. RESULTS Ninety percent used home therapy and 78% a prophylaxis regimen. Only 2% were uninsured. Health insurance was significantly associated with prophylaxis, but not with home therapy. Lower prophylaxis utilization rates were independently associated with having Medicaid, "other," and no insurance as compared to having private insurance. Race, age, inhibitor status, and HTC utilization were also independently associated with both home therapy and prophylaxis. CONCLUSIONS Youth with severe hemophilia who annually obtain care within the U.S. HTC network had a high level of health insurance, home therapy, and prophylaxis. Exploration of factors associated with insurance coverage and yearly HTC utilization, and interventions to optimize home infusion and prophylaxis among youth of African-American and "other" race/ethnic backgrounds are warranted.
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Affiliation(s)
- Judith R Baker
- Department of Pediatric Hematology/Oncology, University of California Los Angeles, Los Angeles, California 90095, USA.
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Céspedes-Knadle YM, Muñoz CE. Development of a Group Intervention for Teens With Type 1 Diabetes. JOURNAL FOR SPECIALISTS IN GROUP WORK 2011. [DOI: 10.1080/01933922.2011.613898] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Mulvaney SA, Rothman RL, Osborn CY, Lybarger C, Dietrich MS, Wallston KA. Self-management problem solving for adolescents with type 1 diabetes: intervention processes associated with an Internet program. PATIENT EDUCATION AND COUNSELING 2011; 85:140-142. [PMID: 21030194 PMCID: PMC3046216 DOI: 10.1016/j.pec.2010.09.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 09/07/2010] [Accepted: 09/25/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Describe intervention processes associated with an Internet self-management problem solving program for adolescents with type 1 diabetes, and relate participant characteristics to program use. METHODS Forty-one adolescents with type 1 diabetes, aged 13-17, participated in an Internet intervention. RESULTS Participants reported psychosocial self-management barriers related to social issues (45%), time pressures (22%), and emotions (25%). Most adolescents (76%) completed the two guided problem solving cycles, and most (97%) problems were appropriate and specific to diabetes. Of the 61 diabetes problems reported, 92% were mostly or completely solved. Baseline hemoglobin A1c, diabetes duration, and age were not related to online activities, however females posted more often to the forum (U=130.0, Z=2.13, p=.033). The majority of parents (87%) interacted with their child about the website. CONCLUSION Adolescents experience psychosocial barriers to self-management that can be addressed by teaching problem solving via the Internet. PRACTICE IMPLICATIONS An Internet self-management problem solving program with minimal external support provides a viable option for diabetes clinics to improve pediatric diabetes outcomes.
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Affiliation(s)
- Shelagh A Mulvaney
- School of Nursing, Vanderbilt University Medical Center, Nashville, TN 37240, USA.
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Hilliard ME, Guilfoyle SM, Dolan LM, Hood KK. Prediction of adolescents' glycemic control 1 year after diabetes-specific family conflict: the mediating role of blood glucose monitoring adherence. ACTA ACUST UNITED AC 2011; 165:624-9. [PMID: 21727273 DOI: 10.1001/archpediatrics.2011.86] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To test adherence to blood glucose monitoring (BGM) as a mediator between diabetes-specific family conflict and glycemic control (hemoglobin A(1c) [HbA(1c)] levels) for 1 year. DESIGN Three waves of prospective data spanning 1 year. SETTING Diabetes clinic in a large tertiary care children's hospital in the Midwestern United States. PARTICIPANTS One hundred forty-five dyads composed of an adolescent (aged 13-18 years) with type 1 diabetes mellitus and a parent. MAIN EXPOSURES Adolescent- and parent-rated diabetes-specific family conflict and mean daily BGM frequency obtained through meter downloads. MAIN OUTCOME MEASURE Levels of HbA(1c), abstracted from the medical record. RESULTS In separate general linear models, higher adolescent-rated family conflict scores at baseline predicted less frequent BGM at 6 months (β = -0.08 [P = .01]) and higher HbA(1c) levels at 12 months (β = 0.08 [P = .02]). In the multivariate model including baseline conflict and BGM as predictors of HbA(1c) levels, BGM was a significant predictor (β = -0.24 [P = .007]) and conflict was no longer significant (β = 0.05 [P = .11]), supporting the mediation hypothesis. Post hoc probing showed that BGM explained 24% of the variance in the conflict-HbA(1c) link. The mediation between parent-reported conflict and HbA(1c) levels via BGM adherence was partially supported (conflict predicting HbA(1c) in the zero-order equation, β = -0.24 [P = .004]; multivariate equation, β = 0.06 [P = .02]), and BGM frequency explained 16% of the conflict-HbA(1c) link. CONCLUSIONS Diabetes-specific family conflict in adolescence predicts deteriorations in BGM and subsequent glycemic control for at least 1 year. Results support ongoing intervention research designed to reduce family conflict and thus prevent a trajectory of declining adherence and glycemic control across adolescence.
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Affiliation(s)
- Marisa E Hilliard
- Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Treatment Adherence and Self-management, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 7039, Cincinnati, OH 45229, USA
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Fritsch SL, Overton MW, Robbins DR. The interface of child mental health and juvenile diabetes mellitus. Pediatr Clin North Am 2011; 58:937-54, xi. [PMID: 21855715 DOI: 10.1016/j.pcl.2011.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Diabetes mellitus is a common childhood illness, and its management is often complicated by mental health challenges. Psychiatric comorbidities are common, including anxiety, depression, and eating disorders. The illness can profoundly affect the developing brain and family functioning and have lifelong consequences. The child mental health provider can provide valuable assistance to support the child and family and assessment and treatment of comorbid mental health problems and to promote positive family functioning and normal developmental progress.
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Affiliation(s)
- Sandra L Fritsch
- Child and Adolescent Psychiatry, Maine Medical Center, University of Vermont College of Medicine, Tufts University School of Medicine, 22 Bramhall Street, Portland, ME 04102, USA.
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Daneman D, Frank M, Perlman K, Wittenberg J. The infant and toddler with diabetes: Challenges of diagnosis and management. Paediatr Child Health 2011; 4:57-63. [PMID: 20212991 DOI: 10.1093/pch/4.1.57] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Infants and toddlers comprise a small minority of individuals with type 1 diabetes. However, epidemiological data provide evidence of a trend towards diagnosis at a younger age. These very young children pose significant challenges to both the health care professionals involved in their care as well as to their families. At diagnosis, younger children often do not present with classical symptoms of diabetes. Unless health professionals remain alert to the possibility of diabetes being the underlying cause of a child's illness, the diagnosis may be missed. Once the diabetes has been diagnosed, the major challenge is to set up a treatment regimen that is both reasonable and realistic; in the youngest children, the goal of very tight metabolic control may expose them to episodes of severe hypoglycemia which may lead to subtle cognitive impairments later in life. The therapeutic regimen must balance the naturally erratic eating and exercise patterns of very young children with the need to maintain adequate metabolic control. Setting a blood glucose target range of 6 to 12 mmol/L usually allows this to be accomplished. Diabetes during early childhood creates a psychosocial challenge to the families of these children. Successful management of infants and toddlers with diabetes depends on a well functioning and educated family, the availability of diabetes health care team experienced in the treatment of these youngsters, and the involvement of the extended family, child care personnel and others who play a role in their daily care.
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Chemtob CM, Hochhauser CJ, Shemesh E, Schmeidler J, Rapaport R. Does poor early metabolic control predict subsequent poor control in young children with type 1 diabetes: an exploratory study. J Diabetes 2011; 3:153-7. [PMID: 21599869 DOI: 10.1111/j.1753-0407.2011.00116.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND We sought to determine whether poor metabolic control during the early stages of type 1 diabetes mellitus predicts control during subsequent years. We hypothesized that poor control in the first year after diagnosis would predict poor control in the following year, and that poor control in the second year after diagnosis would predict poor metabolic control in subsequent years. METHODS We conducted a retrospective review of a cohort of urban children treated for diabetes at our institution who were diagnosed between 1992 and 2005. We calculated odds ratios to determine whether control in year 1 or in year 2 predicted control in Years 3-6. Cox regression analyses were used to determine whether poor early control predicted progression to subsequent poor control. RESULTS Metabolic control in the first year after diagnosis was not a good predictor of future control. However, poor metabolic control in the second year after diagnosis was highly predictive of poor control in subsequent years and predicted faster progression to poor control. CONCLUSION The findings suggest that poor metabolic control in year 2 may be a predictor of subsequent poor metabolic control. Targeting prevention interventions to reduce non-adherence and to enhance metabolic control to families that show poor metabolic control in Year 2 may prove to be an optimum investment in terms of improved medical outcomes and enhanced quality of life.
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Affiliation(s)
- Claude M Chemtob
- Department of Psychiatry Pediatrics, Mount Sinai School of Medicine, New York, New York, USA.
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Ratcliffe J, Couzner L, Flynn T, Sawyer M, Stevens K, Brazier J, Burgess L. Valuing Child Health Utility 9D health states with a young adolescent sample: a feasibility study to compare best-worst scaling discrete-choice experiment, standard gamble and time trade-off methods. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2011; 9:15-27. [PMID: 21033766 DOI: 10.2165/11536960-000000000-00000] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
QALYs are increasingly being utilized as a health outcome measure to calculate the benefits of new treatments and interventions within cost-utility analyses for economic evaluation. Cost-utility analyses of adolescent-specific treatment programmes are scant in comparison with those reported upon for adults and tend to incorporate the views of clinicians or adults as the main source of preferences. However, it is not clear that the views of adults are in accordance with those of adolescents on this issue. Hence, the treatments and interventions most highly valued by adults may not correspond with those most highly valued by adolescents. Ordinal methods for health state valuation may be more easily understood and interpreted by young adolescent samples than conventional approaches. The availability of young adolescent-specific health state values for the estimation of QALYs will provide new insights into the types of treatment programmes and health services that are most highly valued by young adolescents. The first objective of this study was to assess the feasibility of applying best-worst scaling (BWS) discrete-choice experiment (DCE) methods in a young adolescent sample to value health states defined by the Child Health Utility 9D (CHU9D) instrument, a new generic preference-based measure of health-related quality of life developed specifically for application in young people. The second objective was to compare BWS DCE questions (where respondents are asked to indicate the best and worst attribute for each of a number of health states, presented one at a time) with conventional time trade-off (TTO) and standard gamble (SG) questions in terms of ease of understanding and completeness. A feasibility study sample of consenting young adolescent school children (n = 16) aged 11-13 years participated in a face-to-face interview in which they were asked to indicate the best and worst attribute levels from a series of health states defined by the CHU9D, presented one at a time. Participants were also randomly allocated to receive additional conventional TTO or SG questions and prompted to indicate how difficult they found them to complete. The results indicate that participants were able to readily choose 'best' and 'worst' dimension levels in each of the CHU9D health states presented to them and provide justification for their choices. Furthermore, when presented with TTO or SG questions and prompted to make comparisons, participants found the BWS DCE task easier to understand and complete. The results of this feasibility study suggest that BWS DCE methods are potentially more readily understood and interpretable by vulnerable populations (e.g. young adolescents). These findings lend support to the potential application of BWS DCE methods to undertake large-scale health state valuation studies directly with young adolescent population samples.
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Affiliation(s)
- Julie Ratcliffe
- Centre for Clinical Change, Flinders University, Adelaide, South Australia, Australia.
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Gentles SJ, Lokker C, McKibbon KA. Health information technology to facilitate communication involving health care providers, caregivers, and pediatric patients: a scoping review. J Med Internet Res 2010; 12:e22. [PMID: 20562092 PMCID: PMC2956233 DOI: 10.2196/jmir.1390] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 01/25/2010] [Accepted: 02/10/2010] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Pediatric patients with health conditions requiring follow-up typically depend on a caregiver to mediate at least part of the necessary two-way communication with health care providers on their behalf. Health information technology (HIT) and its subset, information communication technology (ICT), are increasingly being applied to facilitate communication between health care provider and caregiver in these situations. Awareness of the extent and nature of published research involving HIT interventions used in this way is currently lacking. OBJECTIVE This scoping review was designed to map the health literature about HIT used to facilitate communication involving health care providers and caregivers (who are usually family members) of pediatric patients with health conditions requiring follow-up. METHODS Terms relating to care delivery, information technology, and pediatrics were combined to search MEDLINE, EMBASE, and CINAHL for the years 1996 to 2008. Eligible studies were selected after three rounds of duplicate screening in which all authors participated. Data regarding patient, caregiver, health care provider, HIT intervention, outcomes studied, and study design were extracted and maintained in a Microsoft Access database. Stage of research was categorized using the UK's Medical Research Council (MRC) framework for developing and evaluating complex interventions. Quantitative and qualitative descriptive summaries are presented. RESULTS We included 104 eligible studies (112 articles) conducted in 17 different countries and representing 30 different health conditions. The most common conditions were asthma, type 1 diabetes, special needs, and psychiatric disorder. Most studies (88, 85%) included children 2 to 12 years of age, and 73 (71%) involved home care settings. Health care providers operated in hospital settings in 96 (92%) of the studies. Interventions featured 12 modes of communication (eg, Internet, intranets, telephone, video conferencing, email, short message service [SMS], and manual downloading of information) used to facilitate 15 categories of functions (eg, support, medication management, education, and monitoring). Numerous patient, caregiver, and health care relevant outcomes have been measured. Most outcomes concerned satisfaction, use, usability, feasibility, and resource use, although behavior changes and quality of life were also reported. Most studies (57 studies, 55%) were pilot phase, with a lesser proportion of development phase (24 studies, 23%) and evaluation phase (11 studies, 11%) studies. HIT interventions addressed several recurring themes in this review: establishing continuity of care, addressing time constraints, and bridging geographical barriers. CONCLUSIONS HIT used in pediatric care involving caregivers has been implemented differently in a range of disease settings, with varying needs influencing the function, form and synchronicity of information transfer. Although some authors have followed a phased approach to development, evaluation and implementation, a greater emphasis on methodological standards such as the MRC guidance for complex interventions would produce more fruitful programs of development and more useful evaluations in the future. This review will be especially helpful to those deciding on areas where further development or research into HIT for this purpose may be warranted.
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Affiliation(s)
- Stephen James Gentles
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada.
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Fritsch SL, Overton MW, Robbins DR. The interface of child mental health and juvenile diabetes mellitus. Child Adolesc Psychiatr Clin N Am 2010; 19:335-52, ix. [PMID: 20478503 DOI: 10.1016/j.chc.2010.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Diabetes mellitus is a common childhood illness, and its management is often complicated by mental health challenges. Psychiatric comorbidities are common, including anxiety, depression, and eating disorders. The illness can profoundly affect the developing brain and family functioning and have lifelong consequences. The child mental health provider can provide valuable assistance to support the child and family and assessment and treatment of comorbid mental health problems and to promote positive family functioning and normal developmental progress.
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Affiliation(s)
- Sandra L Fritsch
- Child and Adolescent Psychiatry, Maine Medical Center, University of Vermont College of Medicine, Tufts University School of Medicine, Portland, ME 04102, USA.
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Greene MS, Mandleco B, Roper SO, Marshall ES, Dyches T. Metabolic control, self-care behaviors, and parenting in adolescents with type 1 diabetes: a correlational study. DIABETES EDUCATOR 2010; 36:326-36. [PMID: 20200283 DOI: 10.1177/0145721710361270] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this pilot study was to explore relationships among metabolic control, self-care behaviors, and parenting in adolescents with type 1 diabetes. METHODS Twenty-nine adolescents (mean age, 14.1 years) and their parents participated. Metabolic control was determined by an average of 4 A1C values taken prior to study enrollment; self-care behaviors were measured with a 12-item self-report questionnaire; parenting style was evaluated using the Parenting Practices Report. RESULTS The mean for A1C values was 8.5%; the mean for overall self-care behaviors was 4.93 (5 = usually). Participants rated themselves highest on the self-care behaviors of giving insulin shots when indicated and adjusting insulin when eating a lot. They ranked themselves lowest on eating a low-fat diet and testing urine for ketones. Parents tended to be more authoritative in their approaches to parenting than either authoritarian or permissive. A significant relationship was found between authoritative mothering and adolescent self-care behaviors and metabolic control. Regression analyses controlling for age and length of time with diabetes confirmed the significance of these relationships. Authoritative fathering positively correlated with the self-care behaviors of monitoring blood glucose, taking insulin, and not skipping meals. A relationship was also noted between permissive parenting by mothers/fathers and poorer metabolic outcomes. However, the permissive parenting correlations did not remain significant when controlling for age and length of time with diabetes. CONCLUSIONS Clinicians may help prevent declining participation in self-care behaviors and metabolic control in adolescents with type 1 diabetes by working with parents, particularly mothers, and encouraging authoritative parenting.
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Affiliation(s)
| | - Barbara Mandleco
- The College of Nursing, Brigham Young University, Provo, Utah (Dr Mandleco)
| | | | - Elaine S Marshall
- The School of Nursing, Georgia Southern University, Statesboro, Georgia (Dr Marshall)
| | - Tina Dyches
- The Department of Counseling Psychology and Special Education, Brigham Young University, Provo, Utah (Dr Dyches)
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