Parent Perspectives of School/Daycare Experiences in Young Children Newly Diagnosed With Diabetes

OBJECTIVE

A central part of family adjustment to a new diagnosis of type 1 diabetes (T1D) is integrating T1D management into the child's school/daycare. This may be particularly challenging for young children who rely on adults for their diabetes management. This study aimed to describe parent experiences with school/daycare during the first 1.5 years following a young child's T1D diagnosis.

METHODS

As part of a randomized controlled trial of a behavioral intervention, 157 parents of young children with new-onset (<2 months) T1D reported on their child's school/daycare experience at baseline and at 9- and 15-month post-randomization. We used a mixed-methods design to describe and contextualize parents' experiences with school/daycare. Qualitative data were collected via open-ended responses, and quantitative data were collected from a demographic/medical from.

RESULTS

While most children were enrolled in school/daycare at all time points, over 50% of parents endorsed that T1D affected their child's enrollment, rejection, or removal from school/daycare at 9 or 15 months. We generated five themes related to parents' school/daycare experiences: Child factors, Parent factors, School/Daycare factors, Cooperation between Parents and Staff, and Socio-historical factors. Parents of younger children and those with lower subjective socioeconomic status were significantly more likely to endorse challenges with school/daycare enrollment.

CONCLUSIONS

School/daycare settings present challenges for parents of young children with T1D. Changes may need to occur across contexts to support early childhood education, including advocacy resources for parents to navigate school policies, increased training for school staff, and healthcare team outreach initiatives to parents and schools.

Trans* people’s access to gender-affirming health care: A European comparison

Background

Trans* people's life satisfaction is correlated with established legal frameworks for gender recognition and access to trans*-specific health care (Transgender Europe [TGEU], 2021). TGEU's guidelines to human rights-based principles of trans*-specific health care highlight bodily integrity/autonomy, free self-determination of gender, quality, specialized and decentralized care, and the right to determine reproductive paths as important pillars of gender affirming health care. We conducted a policy comparison across Europe regarding access to gender-affirming health care to assess how adherence to human rights-based principles could be strengthened.

Methods

We compared access to health care across four main domains: legal framework (e.g., legally recognised genders), insurance coverage (e.g., out of pocket costs), access barriers (e.g., legal requirements to access gender-affirming surgery), and health care offers (e.g., hormone replacement therapy). Criteria were developed in guided brainstorming sessions. Three researchers rated 28 countries across 28 items based on available policy documents.

Results

The majority of European countries prescribes a medicalised gender-affirming process rather than a self-decided process. Psychiatric diagnosis is also required in most countries to access gender-affirming health care. Gender-affirming health care is partly financed by statutory health insurance in most of the countries. Not all countries authorise full gender-affirming health care. Especially where statutory health insurance-covered gender-affirming health care relied centralised on single outpatient clinics or hospitals, waiting times between 6-24 months are found.

Conclusions

Many European countries fail to fully comply with TGEU's guidelines to human rights-based principles of trans* health care. Given the negative impact of access barriers on life satisfaction, European countries should target these shortfalls in ensuring gender-affirming health care.

Key messages

• Non- or only partly covered trans* health care contributes to health inequality.

• Regarding trans* people, European countries need to strengthen human-rights based access to gender-affirming health care.

CellTrackVis: analyzing the performance of cell tracking algorithms

Live-cell imaging is a common data acquisition technique used by biologists to analyze cell behavior. Since manually tracking cells in a video sequence is extremely time-consuming, many automatic algorithms have been developed in the last twenty years to accomplish the task. However, none of these algorithms can yet claim robust tracking performance at the varying of acquisition conditions (e.g., cell type, acquisition device, cell treatments). While many visualization tools exist to help with cell behavior analysis, there are no tools to help with the algorithm's validation. This paper proposes CellTrackVis, a new visualization tool for evaluating cell tracking algorithms. CellTrackVis allows comparing automatically generated cell tracks with ground truth data to help biologists select the best-suited algorithm for their experimented pipeline. Moreover, CellTackVis can be used as a debugging tool while developing a new cell tracking algorithm to investigate where, when, and why each tracking error occurred.

Inoculation route-dependent Lassa virus dissemination and shedding dynamics in the natural reservoir - Mastomys natalensis

Lassa virus (LASV), a Risk Group-4 zoonotic haemorrhagic fever virus, affects sub-Saharan African countries. Lassa fever, caused by LASV, results in thousands of annual deaths. Although decades have elapsed since the identification of the Natal multimammate mouse (Mastomys natalensis) as a natural reservoir of LASV, little effort has been made to characterize LASV infection in its reservoir. The natural route of infection and transmission of LASV within M. natalensis remains unknown, and the clinical impact of LASV in M. natalensis is mostly undescribed. Herein, using an outbred colony of M. natalensis, we investigate the replication and dissemination dynamics of LASV in this reservoir following various inoculation routes. Inoculation with LASV, regardless of route, resulted in a systemic infection and accumulation of abundant LASV-RNA in many tissues. LASV infection in the Natal multimammate mice was subclinical, however, clinical chemistry values were transiently altered and immune infiltrates were observed histologically in lungs, spleens and livers, indicating a minor disease with coordinated immune responses are elicited, controlling infection. Intranasal infection resulted in unique virus tissue dissemination dynamics and heightened LASV shedding, compared to subcutaneous inoculation. Our study provides important insights into LASV infection in its natural reservoir using a contemporary infection system, demonstrating that specific inoculation routes result in disparate dissemination outcomes, suggesting intranasal inoculation is important in the maintenance of LASV in the natural reservoir, and emphasizes that selection of the appropriate inoculation route is necessary to examine aspects of viral replication, transmission and responses to zoonotic viruses in their natural reservoirs.

[Formula: see text]Neurocognitive predictors of adaptive functioning trajectories among youth with spina bifida

Little is known about how youth with spina bifida (SB) acquire adaptive functioning skills across development. Therefore, the current study examined: (1) trajectories of adaptive functioning in youth with SB as they transitioned from childhood into adolescence, and (2) neuropsychological functioning as a potential risk factor for long-term adaptive functioning difficulties. Participants (n = 131 youth with SB) were recruited as part of a larger ongoing longitudinal study. Growth curves were used to examine changes over time across six adaptive functioning skills: communication, self-direction, functional academics, social, self-care, and home living skills. Additionally, youth's attention and executive functioning (i.e., working memory, planning/organizational skills, cognitive flexibility, inhibition) were assessed via questionnaires and performance-based assessments, and entered as predictors in the models. Youth's communication, self-direction, functional academics, self-care, and home living skills increased over time across age, whereas youth's social skills did not. Scaled scores for youth's social, communication, self-direction, and functional academics skills were generally within normal limits, whereas those for self-care and home living skills fell in the borderline range. Better attention and executive functioning predicted a higher intercept for many adaptive functioning abilities at 11.5 years old, above and beyond the influence of IQ. However, these variables did not predict growth in adaptive functioning. Results indicate that youth with SB acquire skills across development to better meet the demands of daily life. However, youth with poorer neurocognitive functioning may demonstrate adaptive functioning deficits in early childhood and benefit from timely intervention.

The Transition to Adult Health Care in Youth With Spina Bifida: Theory, Measurement, and Interventions

PURPOSE

This article focuses on the transition to adult health care in youth with spina bifida (SB) from the perspective of theory, measurement, and interventions.

METHODS

The purpose of this article is to discuss (a) a theory of linkages between the transfer of medical responsibility from parent to child and the transition from pediatric to adult health care, as mediated by transition readiness; (b) measurement issues in the study of self-management and the transition to adult health care; and (c) U.S.-based and international interventions focused on the transition to adult health care in young adults with SB.

FINDINGS

Individuals with SB must adhere to a complex multicomponent treatment regimen while at the same time managing a unique array of cognitive and psychosocial challenges and comorbidities that hinder self-management, medical adherence, and the transition to adult health care. Moreover, such youth endure multiple transitions to adult health care (e.g., in the areas of urology, orthopedics, neurosurgery, and primary care) that may unfold across different time frames. Finally, three transition-related constructs need to be assessed, namely, transition readiness, transition completion, and transition success.

CONCLUSIONS

SB provides an important exemplar that highlights the complexities of conducting research on the transition to adult health care in youth with chronic health conditions. Many transition trajectories are possible, depending on the functioning level of the child and a host of other factors. Also, no single transition pathway is optimal for all patients with SB.

CLINICAL RELEVANCE

The success of the process by which a child with SB transitions from pediatric to adult health care can have life-sustaining implications for the patient.

The Adolescent/Young Adult Self-Management and Independence Scale (AMIS-II): Expanding evidence for validity and reliability

PURPOSE

The purpose of this longitudinal study was to evaluate the internal consistency reliability and construct validity of the Adolescent/Young Adult Self-Management and Independence Scale-II (AMIS-II), an interview-based measure of self-management for youth with chronic health conditions.

METHODS

A diverse sample of adolescents and young adults (AYA) with spina bifida (SB) (n = 64 AYA; mean 20.88; age range 18-25 years) completed an AMIS-II interview. Six years earlier, parents from 55 families completed questionnaires that assessed children's responsibility for SB-related care (Sharing of Spina Bifida Management Responsibilities) and their ability to perform skills across condition-related tasks (The Spina Bifida Independence Survey). Parents also reported on child's communication skills, adaptive behaviors, and independent management of finances (Adaptive Behavior Assessment System-Second Edition; Scales of Independent Behavior-Revised). Descriptive and correlational analyses were conducted to assess the construct validity and the internal consistency reliability of the AMIS-II.

RESULTS

The AMIS-II demonstrated excellent internal consistency reliability (AMIS-II total scale α= 0.95; subscales α= 0.90 -0.91). Evidence in support of construct validity was found in associations between the AMIS-II and measures of child responsibility for SB-related care, ability to perform condition-related skills, and adaptive behaviors (r's = 0.378 -0.777; p's < 0.05).

CONCLUSION

This study provides further evidence of strong reliability and validity for the AMIS-II. Additional research with this measure will facilitate a better understanding of factors related to self-management behaviors in adolescents and young adults with spina bifida.

Longitudinal associations between neuropsychological functioning and medical responsibility in youth with spina bifida: The moderational role of parenting behaviors

For youth with spina bifida (SB), the transfer of medical responsibilities from parent- to self-management is an important component of autonomy development. Youth with SB are at risk for neurocognitive impairments with inattention and executive dysfunction, which may impact their ability to take responsibility for medical tasks. However, adaptive parenting may buffer against the negative impact of executive/attentional dysfunction on levels of medical responsibility. Thus, this study examined the moderating roles of parenting behaviors and child age on the longitudinal associations between neuropsychological functioning and medical responsibility in youth with SB. Participants were recruited as part of a larger, longitudinal study. Youth with SB (N = 89, Mage = 11.10 years) completed a neuropsychological battery of executive functioning and attention measures at Time 1 (T1). Parents reported on youth's executive functioning/attention skills at T1, and child medical responsibility two years later at Time 2 (T2). Observational methods were used to assess parenting behaviors (warmth, behavioral and psychological control) at T1. Attention and cognitive shifting skills at T1 were positively related to child medical responsibility at T2. Two-way interactions between planning/organizing skills and paternal acceptance, and planning/organizing skills and paternal psychological control, were found. A three-way interaction between cognitive shifting skills, maternal acceptance, and child age was found. When conceptualizing risk factors for low medical responsibility in youth with SB, it is important to consider the family context beyond individual, cognitive factors. The results are discussed within the wider context of social-ecological models of medical responsibility.

Predictors of Distinct Trajectories of Medical Responsibility in Youth with Spina Bifida

OBJECTIVE

To determine if there are distinct developmental trajectories of medical responsibility in youth with spina bifida (SB) across ages 8-17 years and to identify condition-related, parental, and family systems predictors of membership in these trajectory groups.

METHODS

Participants were 140 youth with SB and their parents who participated in four waves of a longitudinal study across 6 years (ages 8-15 years at Time 1). Multi-method (questionnaires and observed family interactions) and multi-respondent assessments were conducted during home visits.

RESULTS

Findings revealed that there were two distinct developmental trajectories that characterized this sample, with one being labeled "high increasing" (two thirds of the sample) and one labeled "low increasing" (one third of the sample). Most predictor variables were significantly associated with trajectory group membership, with the exception of ethnicity, SES, and measures of conflict. When all significant univariate predictors were included in the same model, only intelligence quotient (IQ), family stress, and gender were retained as significant.

CONCLUSIONS

Most youth exhibited relatively rapid increases in responsibility over the course of late childhood and adolescence, but there was a smaller portion of the sample that did not exhibit this type of developmental trajectory. The magnitude of the IQ effect on group differentiation appeared to attenuate the effects of most other predictors. It will be important for clinicians working with youth with SB to recognize that the transfer of medical responsibility from parent to child cannot be expected to unfold in the same manner for all families of youth with SB.

Similarities and intersections – A comprehensive view in three studies

Background

Various groups face difficulties in access to, and usage of health care. Research on marginalization in health care, and programs aiming to reduce inequalities usually focus on one single group at a time. Regarding the heterogeneity of groups defined by a few social characteristics, our aim was to question the specificity of barriers, and similarities between different groups.

Methods

The results of a mixed methods study focusing on elderly people with Turkish migration background were compared to the interim results of a qualitative study focusing on transgender persons, and the interim results of a qualitative study focusing persons with trauma related psychiatric diagnoses.

Results

1) While relevant barriers in access to, and usage of health care seem to be group-specific at the first view, their underlying mechanisms of emergence are analogous. 2) Beside more obvious similarities, 3) further barriers arise by the combination of more than the mainly addressed characteristics of the different groups.

Conclusions

Barriers analogous or similar among different groups lead to underlying structural or professionality-related issues. If different dimensions of marginalization intersect, they may be disguised by a concentration on single characteristics. To target health inequalities on the long term, a closer look on similarities between groups facing health inequalities could improve the development of programs for a broader range of persons.

Key messages

The comparison of different marginalized groups is useful to identify and target systematic inequalities in health care. Researchers and stakeholders should consider mechanisms of multiple marginalization.

Pathways by which Maternal Factors are Associated With Youth Spina Bifida-Related Responsibility

OBJECTIVE

Achieving condition-related autonomy is an important developmental milestone for youth with spina bifida (SB). However, the transfer of condition-related responsibility to these youth can be delayed due to parent factors. This study aimed to investigate two potential pathways by which maternal factors may be associated with condition-related responsibility among youth with SB: (a) Maternal adjustment → perception of child vulnerability (PPCV) → youth condition-related responsibility; and (b) Maternal PPCV → overprotection → youth condition-related responsibility.

METHODS

Participating youth with SB (N = 140; Mage=11.4 years, range = 8-15 years) were recruited as part of a longitudinal study; data from three time points (each spaced 2 years apart) from the larger study were used. Mothers reported on personal adjustment factors, PPCV, and overprotection. An observational measure of overprotection was also included. Mothers, fathers, and youth with SB reported on youths' degree of responsibility for condition-related tasks. Analyses included age, lesion level, IQ, and the dependent variables at the prior wave as covariates.

RESULTS

Bootstrapped mediation analyses revealed that PPCV significantly mediated the relationship between maternal distress and youth responsibility for medical tasks such that higher levels of distress at Time 1 predicted higher levels of PPCV at Time 2 and lower youth medical responsibility at Time 3. Furthermore, self-reported maternal overprotection significantly mediated the relationship between maternal PPCV and youth responsibility for medical tasks.

CONCLUSIONS

Maternal personal distress, PPCV, and self-reported overprotection are interrelated and affect youth's condition-related responsibility. Interventions for mothers of youth with SB that target these factors may improve both maternal and youth outcomes.

A Systematic Review of Behavioral Intervention Technologies for Youth With Chronic Health Conditions and Physical and Intellectual Disabilities: Implications for Adolescents and Young Adults With Spina Bifida

OBJECTIVE

Behavioral intervention technologies (BITs) stand as a promising delivery mechanism that overcomes multiple condition-specific and access barriers for self-management interventions for adolescents and young adults with spina bifida (AYA-SB). The purpose of the current review was to synthesize the behavioral and self-management intervention literature in conditions that have overlapping symptoms with youth with SB and to develop a model of likely user needs for AYA-SB that promotes self-management.

METHOD

The search strategy was conducted by a medical research librarian in the following databases: MEDLINE (Ovid), EMBASE (Elsevier), PsycINFO (EbscoHost), the Cochrane Library (Wiley), and Web of Science (Thomson Reuters) databases. The review was based on a systematic narrative synthesis framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (registration number CRD42018092342).

RESULTS

In total, 18 articles were included in the current BIT review. The majority of included studies (1) targeted the management of chronic health conditions, (2) were informed by evidence-based approaches, (3) relied on content delivery, (4) were Web-based, (5) used linear or user-driven workflows, (6) included professional human support, and (7) included a control condition.

CONCLUSIONS

Many of the evaluated BITs resulted in acceptable usage and maintained or improved targeted symptoms. A user needs model for AYA-SB is proposed with the intention that future research will promote further refinement and ultimate deployment of a BIT for AYA-SB to promote self-management.

Determination of Bronopol, Bronidox, and Methyldibromo Glutaronitrile in Cosmetics by Liquid Chromatography with Electrochemical Detection

A method for the simultaneous determination of methyldibromo glutaronitrile, bronopol, and broni-dox in cosmetics, based on liquid chromatography with electrochemical detection, is described. The method is suitable for both aqueous products and emulsions. The detection limit is better than 0.002% for all analytes. Recoveries from an emulsion, spiked to concentrations of 0.03% of the analytes, were 100.4% for bronopol [relative standard deviation (RSD), 0.43%], 97.1% for bronidox (RSD, 0.83%), and 98.4% for methyldibromo glutaronitrile (RSD, 1.7%). Repeatabilities were calculated from 10 replicate analyses of commercial samples. The repeatability for bronopol from an emulsion containing 0.047% bronopol was 0.0027% (RSD, 1.99%); for bronidox from a lotion containing 0.027% bronidox, 0.0014% (RSD, 1.86%); and for methyldibromo glutaronitrile from an emulsion containing 0.031% methyldibromo glutaronitrile, 0.0019% (RSD, 2.16%). A ruggedness test showed that sample amount influenced the results for all 3 analytes. The results obtained for bronidox also depended on detection parameters and composition of extraction solvent. The method was applied to 138 cosmetic products and performed trouble free during these analyses. Bronopol was found in 14 samples, and bronidox was found in 4 samples, including a baby hair lotion, in which it is prohibited. Methyldibromo glutaronitrile was present in 27 samples, including creams, lotions, and sun protection cosmetics.

Technology usage and barriers to the use of behavioral intervention technologies in adolescents and young adults with spina bifida

PURPOSE

The majority of behavioral intervention technologies (BITs) have been designed and targeted towards the general population (i.e., typically-developing individuals); thus, little is known about the use of BITs to aid those with special needs, such as youth with disabilities. The current study assessed adolescents and young adults with spina bifida (AYA-SB) for: 1) their technology usage, and 2) anticipated barriers to using technology to help manage their health.

METHODS

AYA-SB completed a survey of their media and technology usage. A card sorting task that ranked and grouped anticipated barriers to using a mobile app to manage health was also completed. Ranked means, standard deviations, and the number of times a barrier was discarded were used to interpret sample rankings.

RESULTS

AYA-SB reported less frequent technology and media use than the general population. However, differences emerged by age, with young adults endorsing higher usage than their younger counterparts. Top concerns focused on usability, accessibility, safety, personal barriers due to lack of engagement, technological functioning, privacy, and efficacy.

CONCLUSIONS

AYA-SB appear to be selective users of technology. It is therefore critical that the design of BITs address their concerns, specifically aiming to have high usability, accessibility, and engagement.

Quantitative Determination of Paralytic Shellfish Poisoning Toxins in Shellfish Using Prechromatographic Oxidation and Liquid Chromatography with Fluorescence Detection: Collaborative Study

A collaborative study was conducted for the determination of paralytic shellfish poisoning (PSP) toxins in shellfish. The method used liquid chromatography with fluorescence detection after prechromatographic oxidation of the toxins with hydrogen peroxide and periodate. The PSP toxins studied were saxitoxin (STX), neosaxitoxin (NEO), gonyautoxins 2 and 3 (GTX2,3; together), gonyautoxins 1 and 4 (GTX1,4; together), decarbamoyl saxitoxin (dcSTX), B-1 (GTX5), C-1 and C-2 (C1,2; together), and C-3 and C-4 (C3,4; together). B-2 (GTX6) toxin was also included, but for qualitative identification only. Mussels, both blank and naturally contaminated, were mixed and homogenized to provide a variety of PSP toxin mixtures and concentration levels. The same procedure was followed with clams, oysters, and scallops. Twenty-one test samples in total were sent to 21 collaborators who agreed to participate in the study. Results were obtained from 18 laboratories representing 14 different countries. It is recommended that the method be adopted First Action by AOAC INTERNATIONAL.

A Longitudinal Study of Depressive Symptoms, Neuropsychological Functioning, and Medical Responsibility in Youth With Spina Bifida: Examining Direct and Mediating Pathways

Objective

Given the increased risk for cognitive deficits and development of depressive symptoms in youth with spina bifida (SB), this study aimed to examine two pathways through which depressive symptoms and neuropsychological dysfunction may be associated with medical autonomy in this population: (1) depressive symptoms as predictors of medical autonomy as mediated by attention/executive functioning (the cognitive scarring model), and (2) attention/executive functioning as predictors of medical autonomy as mediated by depressive symptoms (the cognitive vulnerability model).

Methods

Participants were recruited as part of a larger, longitudinal study, and included 114 youth with SB (M age = 10.96 at Time 1), their parents, and teachers. Neuropsychological constructs included attention, working memory, and planning/organizing abilities, which were measured with questionnaire and performance-based data. Depressive symptoms and medical responsibility were assessed via questionnaires from multiple respondents.

Results

Bootstrapped mediation analyses revealed that teacher-reported depressive symptoms significantly mediated the relations between neuropsychological functioning (i.e., attention and working memory) and medical responsibility (all p's < .05); neuropsychological dysfunction did not mediate the relationship between depressive symptoms and medical responsibility.

Conclusions

One way in which neurocognitive dysfunction may hinder the development of medical autonomy in youth with SB is through an increased risk for depressive symptoms.

Parental Perceptions of Child Vulnerability in Families of Youth With Spina Bifida: the Role of Parental Distress and Parenting Stress

Objective

This longitudinal study aimed to investigate parental distress and parenting stress in relation to parental perception of child vulnerability (PPCV) in youth with spina bifida (SB).

Methods

Parents of 140 youth with SB (ages 8-15 years at Time 1) were recruited as part of a longitudinal study; data were collected at two time points, spaced 2 years apart. Mothers and fathers completed questionnaires assessing levels of personal distress, parenting stress, and PPCV.

Results

Mothers and fathers reported similar levels of personal distress, parenting stress, and PPCV, but reports of PPCV increased over time. For mothers, both personal distress and parenting stress were significantly associated with PPCV cross-sectionally, but not longitudinally. For fathers, there were significant cross-sectional and longitudinal associations between parenting stress and PPCV. The cross-sectional association between maternal parenting stress and PPCV was moderated by age, with a significant association only for older youth.

Conclusions

For parents of youth with SB, personal distress, and parenting stress are related to parental perceptions of child vulnerability, and child age may moderate this relationship. Parental personal distress and parenting stress are important targets for future interventions.

Transnational medication management by elderly migrants – a mixed-methods approach

Background

Many elderly people of Turkish origin choose a transnational lifestyle and commute between Germany and Turkey every few months. These circular migrants often suffer from chronic diseases. The transnational lifestyle can lead to discontinuities in long-term medication and irregular check-ups. If continuity of care is not ensured transnationally, health risks arise.

Methods

In a mixed-methods study 8 expert-interviews with general practitioners and 25 guideline interviews were conducted with circular migrants to analyze their medication adherence. Additional quantitative analyses were conducted based on data from a German statutory health insurance popular with migrants to investigate discontinuities of prescribed medication.

Results

Cross-border care involves different health risks with regard to medication adherence. For example, patients in Germany rarely receive the amount of medication they need for their stay in Turkey and there are discontinuities in medication delivery. The multi-perspective insight into the patients’ experiences of medical care and the view of general practitioners shows strong variations of preferred strategies to handle the challenges of transnational medication management. Single strategies, such as leaving the health insurance card in one state for prescription and sending of medication through family members or asking for higher amounts of medication to store before travel, lead to frustration both at GPs’ and patients’ sides. GPs experience high pressure by the health system’s structure in providing good care for the patients, especially in providing enough time for information transfer between GPs and patients.

Conclusions

Transnational solutions for health care, and in particular medication care, such as an interprofessional collaborative care across borders or transnational e-health records need to be developed.

Key messages

A transnational lifestyle can lead to discontinuities in the provision of medication. Transnational, inter-professional cooperation is needed to ensure continuity of health care for circular migrants.

The influence of culturalisation on GP consultations and in research on GP care

Background

General practitioners (GPs) have a gatekeeping function in the healthcare system. Research shows that patients of Turkish origin in Germany manage to access specialist care less often than non-immigrant patients. Underlying could be problems related to interactions with the GP. Focusing on interaction instead of individual patients’ characteristics might help identifying underappreciated barriers in health care.

Methods

We conducted a scoping review to identify research on interaction-related aspects of GP consultations of people of Turkish origin. Goffman’s interactional theory was used for operationalisation. Analysis focused on the process of consultation from the perspectives of patients, GPs, and interpreters. Additionally, noticeable issues in researchers’ perspectives on migrants’ utilization of health care were identified.

Results

Patients of Turkish origin expect similar professional performances from their GPs as patients without a migration background. If informal interpreters take part, misinformation might remain unrecognised. Frequently, GPs experience insecurity, which sometimes results in lower empathy and prejudice-based, unprofessional reactions or misdiagnoses. Researchers’ interpretations refer partly to unfounded explanations such as a homogeneous Turkish culture or somatization tendencies of Turkish patients.

Conclusions

Difficulties in GP care of patients of Turkish origin, and access barriers to specialist care, arise less from culture-bound performances of these patients as from culturalising expectations and performances of GPs. Researchers often show similar expectations and interpretations. Such culturalising interpretations should be avoided in future research.

Key messages

Difficulties in GP care of patients of Turkish origin, and access barriers to specialist care, arise less from culture-bound performances of these patients as from culturalising expectations of GPs. Future research should avoid culturalising interpretations.

Cultural Considerations for Autonomy and Medical Adherence in a Young Palestinian American Muslim Female With Spina Bifida: A Longitudinal Case Study in a Research Context

This case study examines the unique presentation of a young Palestinian-American Muslim female, who is a part of an ongoing longitudinal study examining family and peer relationships, psychological adjustment, and neuropsychological functioning in youth with spina bifida. Throughout ten years of data collection, Palestinian-Arab culture and Islamic faith have consistently emerged as important factors that can be considered when interpreting this participant's general level of autonomy, medical autonomy, medical adherence, and psychological adjustment. This case study examines important aspects of adaptive and independent functioning for youth with spina bifida and how this family's culture interacts with these different domains of functioning. Moreover, it explores potential conflicts between an Arab collectivist family structure and Western biomedical ethics and suggests how clinicians might navigate these conflicts and bolster culturally-rooted strengths of families and patients from non-Western backgrounds.

Featured Article: Psychosocial and Family Functioning Among Latino Youth With Spina Bifida

Objective

This study examined differences in psychosocial and family functioning between Latino and non-Latino Caucasian youth with spina bifida (SB), and examined family functioning as a predictor of youth psychosocial functioning as moderated by ethnicity.

Methods

Participants were part of a larger, longitudinal study (Devine, Holbein, Psihogios, Amaro, & Holmbeck, 2012) and included 74 non-Latino Caucasian youth with SB and 39 Latino youth with SB (M age = 11.53, 52.2% female). Data were collected at Time 1 and 2 years later, and included questionnaire and observational data of psychosocial and family functioning.

Results

Latino youth demonstrated fewer externalizing symptoms, less family conflict, but also less social competence. Family conflict was associated with psychosocial functioning in Latino youth, while family cohesion, conflict, and stress were associated with psychosocial functioning in non-Latino Caucasian youth.

Conclusions

Psychosocial and family functioning, and their relationship over time, may be different in Latino versus Caucasian youth with SB.

ADHD and Attention Problems in Children With and Without Spina Bifida

Objectives: To identify differences in the diagnosis and treatment of attention deficit/hyperactivity disorder (ADHD) between typically developing children and children with spina bifida. Method: Sixty-eight children with spina bifida and 68 demographically matched, typically developing children participated in a larger, longitudinal study. Rates of maternal, paternal, and teacher reports of attention problems, as well as rates of maternal reports of ADHD diagnosis, diagnosing provider, pharmaceutical treatment, mental health treatment, and academic accommodations were obtained at 5 time points over a period of 8 years and were compared across groups. Results: Children with spina bifida were more likely to have an ADHD diagnosis and attention problems. Attention problems and ADHD diagnoses were first reported at earlier time points for children with spina bifida than typically developing children. Among children with ADHD or attention problems, children with spina bifida were more likely to be treated with medication, but they were just as likely to use mental health services and receive resource services at school. Conclusions: Children with spina bifida were diagnosed with ADHD and identified as having attention problems more frequently and at an earlier age. This finding could be due to earlier symptom development, greater parental awareness, or more contact with providers. Among those with ADHD or attention problems, stimulant medication was more likely to be prescribed to children with spina bifida, despite research that suggests it may not be as beneficial for them. Further research on the effectiveness of ADHD pharmacological treatment for children with spina bifida is recommended.

Surface-dominated conduction up to 240 K in the Kondo insulator SmB6 under strain

SmB₆ is a strongly correlated mixed-valence Kondo insulator with a newly discovered surface state, proposed to be of non-trivial topological origin. However, the surface state dominates electrical conduction only below T^∗ ≈ 4 K (ref. ), limiting its scientific investigation and device application. Here, we report the enhancement of T^∗ in SmB₆ under the application of tensile strain. With 0.7% tensile strain we report surface-dominated conduction at up to a temperature of 240 K, persisting even after the strain has been removed. This can be explained in the framework of strain-tuned temporal and spatial fluctuations of f-electron configurations, which might be generally applied to other mixed-valence materials. We note that this amount of strain can be induced in epitaxial SmB₆ films via substrate in potential device applications.