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Sand P, Kinberg E, Sundberg F, Forsander G. Parents' and children's experiences of participating in a randomized controlled clinical trial: AIDIT-QS. Int J Qual Stud Health Well-being 2024; 19:2408829. [PMID: 39360673 PMCID: PMC11451326 DOI: 10.1080/17482631.2024.2408829] [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: 02/21/2024] [Accepted: 09/20/2024] [Indexed: 10/04/2024] Open
Abstract
Participation in a paediatric, complex randomized controlled trial (RCT) might add to the family burden when a child is diagnosed with a severe disease. Although important, there are only a limited number of papers describing this aspect of research from the family point of view. This study explored parents' and children's experiences of participation in a research study shortly after the child had been diagnosed with type 1 diabetes. Sixteen parents (nine mothers, seven fathers) and nine children were interviewed by an independent researcher about their inducement, the decision-making process within the family which led to their participation, and their experience of having done so. The result showed that the parents wanted to contribute to improve treatment for children with diabetes in general but also specifically for their own child. Older children were more involved in the decision making than the younger children. Study information needs to be communicated clearly and effectively since decision-making based on information of a clinical trial directly after the child's diabetes onset proved difficult. Being randomized to the intervention group in this specific study was considered somewhat burdensome. However, parental participants in both intervention and control group claimed that they would recommend participation in research studies to other parents in a similar situation, and so did the children. There was no difference between the mothers' and fathers' experiences.
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Affiliation(s)
- Peter Sand
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Emelie Kinberg
- Region Västra Götaland, Department of Psychiatry for Affective Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Frida Sundberg
- Department of Pediatrics, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Pediatrics, Region Västra Götaland, Sahlgrenska University Hospital, Queen Silvia Children’s Hospital, Gothenburg, Sweden
| | - Gun Forsander
- Department of Pediatrics, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Melin J, Lynch KF, Lundgren M, Aronsson CA, Larsson HE, Johnson SB. Factors assessed in the first year of a longitudinal study predict subsequent study visit compliance: the TEDDY study. Eur J Med Res 2023; 28:592. [PMID: 38102669 PMCID: PMC10724932 DOI: 10.1186/s40001-023-01563-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Compliance with a study protocol is central to meeting its research goals. In longitudinal research studies, data loss due to missed visits limit statistical power and introduce bias. The Environmental Determinants of Diabetes in the Young (TEDDY) study is a longitudinal multinational (US, Finland, Germany, and Sweden) investigation of children at risk for type 1 diabetes (T1D) that seeks to identify the environmental triggers of islet autoimmunity and T1D. The purpose of the current study was to identify sociodemographic variables and maternal characteristics assessed in the first year of TEDDY that were associated with study visit compliance in the subsequent 3 years. METHODS Sociodemographic variables, maternal life-style behaviors, post-partum depression, maternal reactions to the child's T1D risk, and study-related variables were collected at child-age 6 months and 15 months. Multiple linear regression was used to examine the association of these variables to study visit compliance in the subsequent 3 years. RESULTS Study visit compliance was highest in Sweden (p > 0.001), in children who were their mother's first child (p > 0.001), and whose mothers were older (p > 0.001) and more satisfied with the TEDDY study (p > 0.001). Father participation was also associated with better study visit compliance (p > 0.001). In contrast, children whose mothers smoked (p > 0.001), suffered from post-partum depression (p = 0.034), and were more anxious about their child's T1D risk (p = 0.002), completed fewer visits. Father's study satisfaction was also associated with study visit compliance (p = 0.029); however, it was not significant in models that included maternal study satisfaction. CONCLUSIONS Sociodemographic variables, maternal characteristics-including study satisfaction-and fathers' participation in the first year of a longitudinal study were associated with subsequent study visit compliance in a sample of children genetically at-risk for T1D followed for 4 years. This information can inform future strategies designed to improve study visit compliance in longitudinal pediatric studies. TRIAL REGISTRATION NCT00279318, 06/09/2004.
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Affiliation(s)
- Jessica Melin
- Department of Clinical Science, Lund University, CRC Hus 60 Pl 11, Box 50332, 202 13, Malmö, Sweden.
| | - Kristian F Lynch
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Markus Lundgren
- Department of Clinical Science, Lund University, CRC Hus 60 Pl 11, Box 50332, 202 13, Malmö, Sweden
- Department of Pediatrics, Kristianstad Hospital, Kristianstad, Sweden
| | - Carin Andrén Aronsson
- Department of Clinical Science, Lund University, CRC Hus 60 Pl 11, Box 50332, 202 13, Malmö, Sweden
| | - Helena Elding Larsson
- Department of Clinical Science, Lund University, CRC Hus 60 Pl 11, Box 50332, 202 13, Malmö, Sweden
- Department of Pediatrics, Skåne University Hospital, Malmö, Sweden
| | - Suzanne Bennett Johnson
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA
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Quinn LM, Narendran P, Randell MJ, Bhavra K, Boardman F, Greenfield SM, Litchfield I. General population screening for paediatric type 1 diabetes-A qualitative study of UK professional stakeholders. Diabet Med 2023; 40:e15131. [PMID: 37151184 DOI: 10.1111/dme.15131] [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: 03/09/2023] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 05/09/2023]
Abstract
AIMS Identifying children at risk of type 1 diabetes allows education for symptom recognition and monitoring to reduce the risk of diabetic ketoacidosis at presentation. We aimed to explore stakeholder views towards paediatric general population screening for type 1 diabetes in the United Kingdom (UK). METHODS Qualitative interviews were undertaken with 25 stakeholders, including diabetes specialists, policymakers and community stakeholders who could be involved in a future type 1 diabetes screening programme in the UK. A thematic framework analysis was performed using the National Screening Committee's evaluative criteria as the overarching framework. RESULTS Diabetic ketoacidosis prevention was felt to be a priority and proposed benefits of screening included education, monitoring and helping the family to better prepare for a future with type 1 diabetes. However, diabetes specialists were cautious about general population screening because of lack of evidence for public acceptability. Concerns were raised about the harms of living with risk, provoking health anxiety and threatening the child's right to an 'open future'. Support systems that met the clinical and psychological needs of the family living with risk were considered essential. Stakeholders were supportive of research into general population screening and acknowledged this would be a priority if an immunoprevention agent were licensed in the UK. CONCLUSIONS Although stakeholders suggested the harms of UK paediatric general population screening currently outweigh the benefits, this view would potentially be altered if prevention therapies were licensed. In this case, an evidence-based screening strategy would need to be formulated and public acceptability explored.
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Affiliation(s)
- Lauren M Quinn
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Parth Narendran
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- Department of Diabetes, University Hospitals of Birmingham, Birmingham, UK
| | | | | | | | - Sheila M Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ian Litchfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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McGorm KJ, Brown JD, Roberts AG, Greenbank S, Brasacchio D, Sawyer ACP, Oakey H, Colman PG, Craig ME, Davis EA, Soldatos G, Thomson RL, Wentworth JM, Couper JJ, Penno MAS. Experiences of Caregivers and At-Risk Children Enrolled in a Prospective Pregnancy-Birth Cohort Study into the Causes of Type 1 Diabetes: The ENDIA Study. CHILDREN 2023; 10:children10040637. [PMID: 37189886 DOI: 10.3390/children10040637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 03/31/2023]
Abstract
Background: We sought research experiences of caregivers and their children were enrolled in the Environmental Determinants of Islet Autoimmunity (ENDIA) study. Methods: ENDIA is a pregnancy–birth cohort investigating early-life causes of type 1 diabetes (T1D). Surveys were sent to 1090 families between June 2021 and March 2022 with a median participation of >5 years. Caregivers completed a 12-item survey. Children ≥ 3 years completed a four-item survey. Results: The surveys were completed by 550/1090 families (50.5%) and 324/847 children (38.3%). The research experience was rated as either “excellent” or “good” by 95% of caregivers, and 81% of children were either “ok”, “happy” or “very happy”. The caregivers were motivated by contributing to research and monitoring their children for T1D. Relationships with the research staff influenced the experience. The children most liked virtual reality headsets, toys, and “helping”. Blood tests were least liked by the children and were the foremost reason that 23.4% of the caregivers considered withdrawing. The children valued gifts more than their caregivers. Only 5.9% of responses indicated dissatisfaction with some aspects of the protocol. The self-collection of samples in regional areas, or during the COVID-19 pandemic restrictions, were accepted. Conclusions: This evaluation identified modifiable protocol elements and was conducted to further improve satisfaction. What was important to the children was distinct from their caregivers.
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Melin J, Lynch KF, Lundgren M, Aronsson CA, Larsson HE, Johnson SB. Is staff consistency important to parents' satisfaction in a longitudinal study of children at risk for type 1 diabetes: the TEDDY study. BMC Endocr Disord 2022; 22:19. [PMID: 35012530 PMCID: PMC8744326 DOI: 10.1186/s12902-021-00929-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Participants' study satisfaction is important for both compliance with study protocols and retention, but research on parent study satisfaction is rare. This study sought to identify factors associated with parent study satisfaction in The Environmental Determinants of Diabetes in the Young (TEDDY) study, a longitudinal, multinational (US, Finland, Germany, Sweden) study of children at risk for type 1 diabetes. The role of staff consistency to parent study satisfaction was a particular focus. METHODS Parent study satisfaction was measured by questionnaire at child-age 15 months (5579 mothers, 4942 fathers) and child-age four years (4010 mothers, 3411 fathers). Multiple linear regression analyses were used to identify sociodemographic factors, parental characteristics, and study variables associated with parent study satisfaction at both time points. RESULTS Parent study satisfaction was highest in Sweden and the US, compared to Finland. Parents who had an accurate perception of their child's type 1 diabetes risk and those who believed they can do something to prevent type 1 diabetes were more satisfied. More educated parents and those with higher depression scores had lower study satisfaction scores. After adjusting for these factors, greater study staff change frequency was associated with lower study satisfaction in European parents (mothers at child-age 15 months: - 0.30,95% Cl - 0.36, - 0.24, p < 0.001; mothers at child-age four years: -0.41, 95% Cl - 0.53, - 0.29, p < 0.001; fathers at child-age 15 months: -0.28, 95% Cl - 0.34, - 0.21, p < 0.001; fathers at child-age four years: -0.35, 95% Cl - 0.48, - 0.21, p < 0.001). Staff consistency was not associated with parent study satisfaction in the US. However, the number of staff changes was markedly higher in the US compared to Europe. CONCLUSIONS Sociodemographic factors, parental characteristics, and study-related variables were all related to parent study satisfaction. Those that are potentially modifiable are of particular interest as possible targets of future efforts to improve parent study satisfaction. Three such factors were identified: parent accuracy about the child's type 1 diabetes risk, parent beliefs that something can be done to reduce the child's risk, and study staff consistency. However, staff consistency was important only for European parents. TRIAL REGISTRATION NCT00279318 .
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Affiliation(s)
- Jessica Melin
- Department of Clinical Sciences, Lund University, Malmö, Sweden.
| | - Kristian F Lynch
- Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Markus Lundgren
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Pediatrics, Kristianstad hospital, Kristianstad, Sweden
| | | | - Helena Elding Larsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Pediatrics, Skåne University Hospital, Malmö, Sweden
| | - Suzanne Bennett Johnson
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA
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Abstract
PURPOSE OF REVIEW Loss of tolerance to insulin likely contributes to the immunopathogenesis of type 1 diabetes (T1D). Several large clinical trials and smaller mechanistic studies have failed to demonstrate the efficacy of insulin antigen therapy. The growing awareness of the heterogeneity of T1D likely affects the response to various immune therapies including insulin. Identification of biomarkers of clinical response will provide further insight into mechanisms leading to the disease and classify responders in the quest for personalized therapy. RECENT FINDINGS Several biomarkers have identified subpopulations in posthoc analyses that showed benefit from oral insulin even though the placebo-controlled study was as a whole unsuccessful. High insulin autoantibody titer, low first phase insulin response, and high Diabetes Prevention Trial-Type 1 Risk Score identify at-risk relatives more likely to benefit from oral insulin. Future incorporation of human leukocyte antigen and the variable number of tandem repeats polymorphism located in the insulin gene promoter (INS VNTR) is of interest for both primary and secondary prevention studies. SUMMARY Although primary and secondary prevention trials using oral insulin are ongoing, those completed have been largely unsuccessful. However, we believe that oral insulin should be considered in future trials as part of combination therapies as prerandomization biomarker testing is refined.
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Affiliation(s)
- Laura M. Jacobsen
- Department of Pediatrics, University of Florida, Gainesville, FL, USA
| | - Desmond A. Schatz
- Department of Pediatrics, University of Florida, Gainesville, FL, USA
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Melin J, Maziarz M, Andrén Aronsson C, Lundgren M, Elding Larsson H. Parental anxiety after 5 years of participation in a longitudinal study of children at high risk of type 1 diabetes. Pediatr Diabetes 2020; 21:878-889. [PMID: 32301201 DOI: 10.1111/pedi.13024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 04/01/2020] [Accepted: 04/06/2020] [Indexed: 02/01/2023] Open
Abstract
AIM Parents of children participating in screening studies may experience increased levels of anxiety. The aim of this study was to assess parental anxiety levels after 5 years of participation in the Diabetes Prediction in Skåne study. Associations between parental anxiety about their child developing type 1 diabetes and clinical, demographic, and immunological factors were analyzed. METHOD Mothers and fathers of participating 5-year-old children answered a questionnaire regarding parental anxiety associated with their child's increased risk of type 1 diabetes. Anxiety levels were assessed using the State Anxiety Inventory scale. Data were analyzed using logistic and multinomial regression. RESULTS Parents of 2088 5-year-old children participated. Both parents answered the questionnaire for 91.2% (n = 1904) of children. In 67.1% of families, neither parent reported being anxious that their child had an increased risk of developing type 1 diabetes. Anxiety was higher in mothers of children positive for autoantibodies (OR 2.21 95% CI 1.41, 3.48, P < .001) and those perceiving their child had a higher risk for type 1 diabetes (2.01; 1.29, 3.13, P = .002). Frequency of worry was associated with parental anxiety (mothers 5.33; 3.48, 8.17, P < .001, fathers 5.27; 3.51, 7.92, P < .001). Having a family member with type 1 diabetes and having lower education level were also associated with increased anxiety. CONCLUSIONS Diabetes in the family, the child's autoantibody status, education level, frequency of worry and risk perception where associated with higher parental anxiety. These findings add to our understanding of the impact of screening for type 1 diabetes in children on parental anxiety.
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Affiliation(s)
- Jessica Melin
- Department of Clinical Sciences, Unit for Pediatric Endocrinology, Lund University, Malmö, Sweden
| | - Marlena Maziarz
- Department of Clinical Sciences, Unit for Pediatric Endocrinology, Lund University, Malmö, Sweden
| | - Carin Andrén Aronsson
- Department of Clinical Sciences, Unit for Pediatric Endocrinology, Lund University, Malmö, Sweden
| | - Markus Lundgren
- Department of Clinical Sciences, Unit for Pediatric Endocrinology, Lund University, Malmö, Sweden
| | - Helena Elding Larsson
- Department of Clinical Sciences, Unit for Pediatric Endocrinology, Lund University, Malmö, Sweden
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Beasant L, Brigden A, Parslow R, Apperley H, Keep T, Northam A, Wray C, King H, Langdon R, Mills N, Young B, Crawley E. Treatment preference and recruitment to pediatric RCTs: A systematic review. Contemp Clin Trials Commun 2019; 14:100335. [PMID: 30949611 PMCID: PMC6430075 DOI: 10.1016/j.conctc.2019.100335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 01/25/2019] [Accepted: 02/13/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Recruitment to pediatric randomised controlled trials (RCTs) can be a challenge, with ethical issues surrounding assent and consent. Pediatric RCTs frequently recruit from a smaller pool of patients making adequate recruitment difficult. One factor which influences recruitment and retention in pediatric trials is patient and parent preferences for treatment. PURPOSE To systematically review pediatric RCTs reporting treatment preference. METHODS Database searches included: MEDLINE, CINAHL, EMBASE, and COCHRANE.Qualitative or quantitative papers were eligible if they reported: pediatric population, (0-17 years) recruited to an RCT and reported treatment preference for all or some of the participants/parents in any clinical area. Data extraction included: Number of eligible participants consenting to randomisation arms, number of eligible patients not randomised because of treatment preference, and any further information reported on preferences (e.g., if parent preference was different from child). RESULTS Fifty-two studies were included. The number of eligible families declining participation in an RCT because of preference for treatment varied widely (between 2 and 70%) in feasibility, conventional and preference trial designs. Some families consented to trial involvement despite having preferences for a specific treatment. Data relating to 'participant flow and recruitment' was not always reported consistently, therefore numbers who were lost to follow-up or withdrew due to preference could not be extracted. CONCLUSIONS Families often have treatment preferences which may affect trial recruitment. Whilst children appear to hold treatment preferences, this is rarely reported. Further investigation is needed to understand the reasons for preference and the impact preference has on RCT recruitment, retention and outcome.
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Affiliation(s)
- L. Beasant
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, UK
| | - A. Brigden
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, UK
| | - R.M. Parslow
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, UK
| | - H. Apperley
- Department of Academic Paediatrics, Royal Alexandra Children's Hospital, Brighton and Sussex University Hospitals, UK
| | - T. Keep
- NHS Greater Glasgow and Clyde, UK
| | - A. Northam
- Department of Primary Care and Public Health, Royal Sussex County Hospital, Brighton and Sussex Medical School, UK
| | - C. Wray
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - H. King
- Bristol Royal Hospital for Children, University Hospitals Bristol NHS Trust, UK
| | - R. Langdon
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - N. Mills
- Population Health Sciences, Bristol Medical School, University of Bristol, UK
| | - B. Young
- Institute of Psychology, Health and Society, University of Liverpool, UK
| | - E. Crawley
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, UK
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Schoen S, Jergens S, Barbaresko J, Nöthlings U, Kersting M, Remer T, Stelmach-Mardas M, Ziegler AG, Hummel S. Diet Quality during Infancy and Early Childhood in Children with and without Risk of Type 1 Diabetes: A DEDIPAC Study. Nutrients 2017; 9:nu9010048. [PMID: 28075358 PMCID: PMC5295092 DOI: 10.3390/nu9010048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 12/14/2016] [Accepted: 12/30/2016] [Indexed: 11/17/2022] Open
Abstract
Previous studies have indicated that mothers of children at increased risk of type 1 diabetes (T1D) may modify their child’s diet following risk notification. Our aim was to investigate the diet quality after notified of T1D risk in at-risk children compared to not-at-risk children. The quality of nutrient intake (PANDiet score) and food intake (analyzed by a newly developed score and the HuSKY score) were assessed using three-day dietary records collected for at-risk children (BABYDIET study, n = 109) and a matched sample of not-at-risk children (DONALD study, n = 205) at nine and 24 months of age. Nutrient and food intake quality were lower at nine months of age and food intake quality was lower at 24 months of age in at-risk than in not-at-risk children (p = 0.01 and p < 0.0001, respectively). The amount of added sugar was higher in at-risk children at both ages (p < 0.0001). In at-risk children, dietary quality was similar between children who were first exposed to gluten at six or 12 months of age. Despite being notified about their child’s risk of T1D, the child’s mother did not switch to healthier diets compared with not-at-risk mothers.
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Affiliation(s)
- Stefanie Schoen
- Research Institute of Child Nutrition, University Clinic Bochum, Bochum 44791, Germany.
| | - Sibille Jergens
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg 85764, Germany.
- Forschergruppe Diabetes e.V., Neuherberg 85764, Germany.
- German Center for Diabetes Research (DZD), München-Neuherberg 85764, Germany.
| | - Janett Barbaresko
- Department of Nutrition and Food Sciences, Nutritional Epidemiology, University of Bonn, Bonn 53115, Germany.
| | - Ute Nöthlings
- Department of Nutrition and Food Sciences, Nutritional Epidemiology, University of Bonn, Bonn 53115, Germany.
| | - Mathilde Kersting
- Research Institute of Child Nutrition, University Clinic Bochum, Bochum 44791, Germany.
| | - Thomas Remer
- DONALD Study Dortmund, Department of Nutrition and Food Sciences, Nutritional Epidemiology, University of Bonn, University Branch Dortmund, Dortmund 44225, Germany.
| | - Marta Stelmach-Mardas
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal 14558, Germany.
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Poznan 60-572, Poland.
| | - Anette-G Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg 85764, Germany.
- Forschergruppe Diabetes e.V., Neuherberg 85764, Germany.
- German Center for Diabetes Research (DZD), München-Neuherberg 85764, Germany.
| | - Sandra Hummel
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Neuherberg 85764, Germany.
- Forschergruppe Diabetes e.V., Neuherberg 85764, Germany.
- German Center for Diabetes Research (DZD), München-Neuherberg 85764, Germany.
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Smith LB, Lynch KF, Baxter J, Lernmark B, Roth R, Simell T, Johnson SB. Factors associated with maternal-reported actions to prevent type 1 diabetes in the first year of the TEDDY study. Diabetes Care 2014; 37:325-31. [PMID: 24041684 PMCID: PMC3898752 DOI: 10.2337/dc13-0449] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 09/11/2013] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Mothers of children at risk for type 1 diabetes report engaging in preventive behaviors. The purpose of this study is to further document these actions in an international, longitudinal sample and examine variables that predict whether mothers engage in these behaviors. RESEARCH DESIGN AND METHODS This study examined an international sample (from Finland, Germany, Sweden, and the U.S.) from the naturalistic, longitudinal The Environmental Determinants of Diabetes in the Young (TEDDY) study, which tracked children genetically at risk for type 1 diabetes from birth to age 15 years. Mothers of 7,613 infants aged 6 months and 6,503 infants aged 15 months completed questionnaires assessing psychosocial factors and actions intended to prevent diabetes. RESULTS Many mothers (29.9% at 6 months and 42.8% at 15 months) reported engaging in a behavior intended to prevent type 1 diabetes, with the largest percentages (20.9-29.2%) reporting making changes to their child's diet (e.g., reducing the consumption of sweets and carbohydrates). Factors related to engaging in preventive behaviors include older maternal age; higher maternal education; minority status; having only one child; having a first-degree relative with type 1 diabetes; being from a country other than Sweden; having an accurate perception of the child's increased risk for developing diabetes; having postpartum depression, maternal anxiety, and worry about the risk of diabetes; and believing that diabetes can be prevented. CONCLUSIONS The findings of this study suggest that many mothers engage in actions to prevent diabetes and highlight the importance of tracking these behaviors to ensure the validity of naturalistic observational studies.
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Driscoll KA, Johnson SB, Schatz DA, Haller MJ. Use of a precious resource: parental decision making about using autologous umbilical cord blood in studies involving young children with type 1 diabetes. Contemp Clin Trials 2011; 32:524-9. [PMID: 21530680 DOI: 10.1016/j.cct.2011.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 03/21/2011] [Accepted: 04/04/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess parental decision making and experiences in an autologous umbilical cord blood infusion study in young children with type 1 diabetes (T1D). METHODS Surveys were completed with 22 parents of children with T1D who received infusion and 22 parents who declined infusion. RESULTS Parents who stored umbilical cord blood were middle-aged, highly-educated, Caucasian, married, and privately insured. Parents of children who did not receive infusion declined because they did not want to deplete their cord blood supply. Parents of children who decided to have their children participate in the infusion study were similar on approaches to storing cord blood and attitudes about research as compared to parents who declined to have their children participate in the infusion. Parents of children who received infusion were positive about their experiences and held expectations that infusion would lead to a T1D cure. CONCLUSIONS The manner in which cord blood is stored needs to be considered so that participation in future studies does not risk depletion of the cord blood supply. In addition, it appears that the process of storing umbilical cord blood leads to restricted demographic characteristics of eligible participants, which may impact recruitment in clinical trials. These results are relevant to designing future cord blood studies in T1D and other non-malignant diseases.
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Affiliation(s)
- Kimberly A Driscoll
- Department of Medical Humanities and Social Sciences, Florida State University College of Medicine, Tallahassee, FL 32306–4300, USA.
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Goldstein E, Hermann R, Renfors TJ, Näntö-Salonen KM, Korhonen T, Kärkkäinen M, Veijola RK, Knip M, Simell TT, Simell OG. From genetic risk awareness to overt type 1 diabetes: parental stress in a placebo-controlled prevention trial. Diabetes Care 2009; 32:2181-3. [PMID: 19752173 PMCID: PMC2782973 DOI: 10.2337/dc09-0423] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the psychological burden of parents facing increasing risk of type 1 diabetes in their children. RESEARCH DESIGN AND METHODS In the population-based Type 1 Diabetes Prediction and Prevention (DIPP) Study, newborn infants with HLA-DQB1-conferred diabetes risk were enrolled in sequential analyses of diabetes-associated autoantibodies. Those persistently positive for at least two autoantibodies were recruited to a randomized double-blinded intervention trial. The experience of stress in parents of 664 children was measured using Parenting Stress Index self-report inventory. RESULTS While diagnosis of diabetes increased parental stress, the appearance of autoantibodies or participation in the intervention trial did not. Mothers had higher stress levels than fathers. Single parenthood and chronically ill family members increased parental stress. CONCLUSIONS Parental stress was not increased by notification of autoantibody positivity or by participation in an intervention trial. Other demanding family conditions contributed to the experience of stress.
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Current literature in diabetes. Diabetes Metab Res Rev 2009; 25:i-x. [PMID: 19790194 DOI: 10.1002/dmrr.1037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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