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Cha E, Son NH, Joung KH, Shin YA, Kim HJ, Kim H, Faulkner MS. Differences in patient-reported and clinical characteristics by age group in adults with type 2 diabetes. Worldviews Evid Based Nurs 2024. [PMID: 38500018 DOI: 10.1111/wvn.12715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 12/06/2023] [Accepted: 01/27/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND The global burden of type 2 diabetes (T2D) is growing, and the age of onset is widening, resulting in increasing numbers of young adults and elderly patients with T2D. Age-specific diabetes care needs have yet to be fully explored. AIMS This study examined (1) differences in patient-reported and clinical characteristics by age group and (2) the effect of age on two proxy measures assessing psychological health and self-care adherence after adjusting for potential mediators. METHODS A cross-sectional, correlational design was used. Adults with type 2 diabetes (T2D) were recruited from a university hospital in Korea between 2019 and 2020. Participants were divided into four groups based on years of age (40s and younger group [n = 27]; 50s group [n = 47]; 60s group [n = 54]; and 70s and older group [n = 48]) to compare patient-reported and clinical characteristics. Chi-square tests, ANOVA, Kruskal-Wallis tests, and logistic regression analysis were performed to assess group differences and effect of age on psychological health and self-care adherence. RESULTS Of 178 participants, two-thirds were men (n = 114; 64.41%). The mean ages in the 40s and younger, 50s, 60s, and 70s and older groups were 39.4, 54.7, 63.9, and 76.0 years, respectively. There were significant differences in patient-reported and clinical characteristics by age group. The youngest group reported the poorest psychological health and self-care behaviors. Although the oldest group showed the poorest physical functioning, this group also showed the highest self-care adherence and the best psychological health. Regarding clinical characteristics, traditional diabetes-related blood test results showed no significant group differences. LINKING EVIDENCE TO ACTION Age-specific diabetes care needs were identified in adults with T2D. Interventions to improve psychological health and priming effects of behavioral adherence need to be developed. Furthermore, meticulous investigation to detect potential complications early is essential in adults with T2D.
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Affiliation(s)
- EunSeok Cha
- College of Nursing, Chungnam National University, Daejeon, South Korea
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Nak-Hoon Son
- Department of Statistics, College of Natural Science, Keimyung University, Daeggu, South Korea
| | - Kyong Hye Joung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Yun-A Shin
- College of Sport Science, Dankook University, Cheonan, South Korea
| | - Hyun Jin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Hyukjin Kim
- Department of Statistics, College of Natural Science, Keimyung University, Daeggu, South Korea
| | - Melissa Spezia Faulkner
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
- Byrdine F. Lewis School of Nursing and Health Professions, Georgia State University, Atlanta, Georgia, USA
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Cha E, Choi Y, Bancks M, Faulkner MS, Dunbar SB, Umpierrez GE, Reis J, Carnethon MR, Shikany JM, Yan F, Jacobs DR. Longitudinal changes in diet quality and food intake before and after diabetes awareness in American adults: the Coronary Artery Risk Development in Young Adults (CARDIA) study. BMJ Open Diabetes Res Care 2024; 12:e003800. [PMID: 38453235 PMCID: PMC10921527 DOI: 10.1136/bmjdrc-2023-003800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 12/15/2023] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION Limited longitudinal research is available examining how American adults make dietary changes after learning they have diabetes. We examined the associations between diabetes awareness and changes in dietary quality and food intake in a prospective cohort from the Coronary Artery Risk Development in Young Adults (CARDIA) study. RESEARCH DESIGN AND METHODS A nested case-control design was used. In the original CARDIA study, black and white participants were recruited from four US urban areas and partitioned into one control group (no diabetes over 30-year follow-up) and three case groups (early-onset, intermediate-onset, later-onset diabetes groups) based on timing of diagnosis and first awareness of diabetes. Estimated mean A Priori Diet Quality Score (APDQS), and food subgroup intake were examined at three CARDIA examinations (year (Y)0, Y7, and Y20). The mean APDQS with 95% CIs and food intake (servings/day) were compared across the one control group and three case groups using exam-specific and repeated measures linear regression. RESULTS Among 4576 participants (mean age: 25±4 years; 55% female; 49% black race), 653 incident cases (14.3%) of diabetes were observed over 30 years. APDQS was lowest at Y0 when the diabetes-free participants were aged 18-30 years (61.5-62.8), but increased over 20 years with advancing age across all groups (64.6-73.3). Lower APDQS in young adulthood was associated with a higher incidence of diabetes later in life. Diabetes awareness was associated with a net increase of 2.95 points in APDQS. The greatest increase of APDQS was when people learned of their diabetes for the first time (an increase of 5.71 in early-onset and 6.64 in intermediate-onset diabetes groups, respectively). CONCLUSIONS Advancing age and diabetes awareness were associated with more favorable dietary changes leading to improved diet quality. Optimal diet quality and healthy food intake in young adulthood seem important to prevent diabetes later in life.
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Affiliation(s)
- EunSeok Cha
- College of Nursing, Chungnam National University, Daejeon, The Republic of Korea
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Yuni Choi
- Columbia University Irving Medical Center, New York, New York, USA
| | - Michael Bancks
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Sandra B Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | | | - Jared Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Northwestern University, Evanston, Illinois, USA
| | - James M Shikany
- The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Fengxia Yan
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - David R Jacobs
- School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA
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Spratling R, Ali SZ, Faulkner MS, Feinberg I, Hayat MJ. Enhancing caregivers self-management for their children who require medical technology: A feasibility study for the COPE-STAR intervention. J Pediatr Nurs 2024; 75:23-30. [PMID: 38096760 DOI: 10.1016/j.pedn.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/08/2023] [Accepted: 12/08/2023] [Indexed: 03/08/2024]
Abstract
PURPOSE To test feasibility of the Creating Opportunities for Personal Empowerment: Symptom and Technology Management Resources intervention for caregivers of children who require medical technologies of tracheostomies and feeding tubes. DESIGN AND METHODS Quasi-experimental one group design with measures at baseline and at 4 weeks. Intervention feasibility was tested from August 2019-June 2021, including recruitment, retention, and adherence, and caregiver satisfaction. Caregiver and child characteristics and outcomes were assessed. RESULTS Caregivers were enrolled (n = 22) and completed (n = 16) the study. Caregivers were primarily female (n = 21), were predominately Caucasian (n = 14, 64%) followed by African-American (n = 8, 36%), and Non-Hispanic/Latino (n = 18, 82%). Feasibility indicators of recruitment (92%), retention (73%), and adherence (100%) were satisfactory. Outcome measures of management of child's chronic condition, caregiver beliefs about managing their child's symptoms and medical technology, anxiety, and depressive symptoms remained stable. Caregivers agreed that the intervention was useful, easy to use, and acceptable, and had positive feedback. CONCLUSIONS This is a feasible and acceptable intervention. With further development and efficacy testing, the intervention has potential for use and expansion to a larger population of caregivers of children who require medical technology. PRACTICE IMPLICATIONS Children who require medical technology have multiple complex chronic conditions and complex care needs at home. This intensive and focused care is provided by informal caregivers who need education and resources for their child's care. This intervention addressed caregiver management of common symptoms and medical technologies of children in the home setting.
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Affiliation(s)
- Regena Spratling
- Professor, School of Nursing, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, 140 Decatur Street, Urban Life Building Room 950, Atlanta, GA 30303, USA.
| | - Syeda Zahra Ali
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Melissa Spezia Faulkner
- Adjunct Professor, School of Nursing, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, USA.
| | - Iris Feinberg
- Associate Director, Adult Literacy Research Center, College of Education and Human Development, Georgia State University, USA.
| | - Matthew J Hayat
- Chair & Professor of Biostatistics, Department of Population Health Sciences, School of Public Health, Byrdine F. Lewis College of Nursing & Health Professions (Joint), Georgia State University, USA.
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Cha E, Joung KH, Shin YA, Son NH, Kim HJ, Faulkner MS. Comparisons of Psycho-Behavioral Factors, Body Composition, and Clinical Outcomes in Adults With Type 2 Diabetes by Perceived Hypoglycemia. Sci Diabetes Self Manag Care 2023; 49:351-361. [PMID: 37658651 DOI: 10.1177/26350106231192362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
PURPOSE The purpose of the study was to examine the associations between perceived hypoglycemia and psycho-behavioral and clinical factors in persons with type 2 diabetes (T2D). METHODS Adults with T2D were recruited from outpatient clinics in a university hospital in Korea. Sociodemographics, psycho-behavioral and clinical factors, and body composition were assessed. The participants were divided into 2 groups reporting perceived hypoglycemia or not in the previous month based on an item of the Control Problem Scale. Group differences were compared at α = .05 using SPSS (version 26.0). RESULTS Of 177 participants, approximately one-third (n = 67) perceived hypoglycemia. The hypoglycemia group reported poor health-related quality of life, frequent blood monitoring and foot care, and sleep difficulties. However, no differences between groups were identified for diet, exercise, or glycosylated hemoglobin. The hypoglycemia group had a lower body mass index and a trend toward a lower skeletal muscle mass and fat free mass. CONCLUSIONS Perceived hypoglycemia was associated with psycho-behavioral factors and body composition. Importantly, some persons on oral antidiabetic medications that do not cause hypoglycemia still perceived hypoglycemia. Further investigation is warranted to examine the efficacy of strategies to minimize hypoglycemia and inappropriate fear of hypoglycemia. In addition, clinicians should be aware of the potential risk of hypoglycemia in persons with lower muscle mass.
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Affiliation(s)
- EunSeok Cha
- College of Nursing, Chungnam National University, Daejeon, South Korea
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Kyong Hye Joung
- Department of Internal Medicine, Chungnam National University, Daejeon, South Korea
| | - Yun-A Shin
- College of Sport Science, Dankook University, Cheonan, South Korea
| | - Nak-Hoon Son
- College of Natural Science, Department of Statistics, Keimyung University, Daegu, South Korea
| | - Hyun Jin Kim
- Department of Internal Medicine, Chungnam National University, Daejeon, South Korea
| | - Melissa Spezia Faulkner
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
- Byrdine F. Lewis School of Nursing and Health Professions, Georgia State University, Atlanta, Georgia
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Faulkner MS. Nurses' voices: Using innovative technology in acute care settings. Nurs Manag (Harrow) 2023; 54:48-52. [PMID: 37104517 DOI: 10.1097/nmg.0000000000000002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Affiliation(s)
- Melissa Spezia Faulkner
- Melissa Spezia Faulkner is an adjunct professor at the Byrdine F. Lewis College of Nursing and Health Professions in Atlanta, Ga., and a nurse scientist at Mayo Clinic in Phoenix, Ariz
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Coombe AH, Hayat MJ, Faulkner MS, Rogers AE, Lee J, Clark PC. Preliminary evidence of insulin resistance in young adults with impaired sleep. J Am Coll Health 2022; 70:1724-1730. [PMID: 33048647 DOI: 10.1080/07448481.2020.1819290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 08/01/2020] [Accepted: 08/28/2020] [Indexed: 06/11/2023]
Abstract
Objective: Impaired sleep is associated with insulin resistance (IR), a precursor to type 2 diabetes mellitus (T2DM), but is poorly understood in young adults. This cross-sectional study examined sleep characteristics, risk factors for T2DM, and IR in college students. Participants: Thirty-two college students (18-25 years) with either short sleep or poor quality sleep were assessed. Methods: Participants completed self-report measures of sleep and T2DM risk factors. One week of objective sleep was measured with wrist actigraphy. IR was calculated from fasting serum glucose and insulin concentrations. Results: The sample slept on average 6.6 hours/night, and over half had IR. Of those with IR, 44.4% had normal body mass index (BMI), 72% had normal fasting glucose concentrations, and all but one had T2DM risk test score indicating they were not at risk. Conclusions: IR was found in over half of participants; however, many typical T2DM risk factors were not present in those with IR.
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Affiliation(s)
- Ashley Helvig Coombe
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Matthew J Hayat
- Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, Georgia, USA
| | | | - Ann E Rogers
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
| | - Jiwon Lee
- Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, Georgia, USA
| | - Patricia C Clark
- Byrdine F. Lewis School of Nursing, Georgia State University, Atlanta, Georgia, USA
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Cha E, Shin MH, Smart M, Jang H, Lee J, Joung KH, Kim HJ, Faulkner MS. Q-Methodology and Psychological Phenotyping to Design Patient-Centered Diabetes Education for Persons With Type 2 Diabetes on Insulin Therapy. Sci Diabetes Self Manag Care 2022; 48:98-110. [PMID: 35118919 DOI: 10.1177/26350106221076035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to identify the psychological phenotypes of persons with type 2 diabetes (T2D) on insulin therapy to better inform personalized diabetes education strategies to improve self-management behaviors. METHODS Q-methodology, a research approach combining the quantitative rigor of statistical analysis with qualitative data on perception of diabetes self-management by persons with T2D on insulin therapy, was used. The Summary of Diabetes Self-Care Activity measure and A1C in the past 6 months were used to further describe self-management behaviors of each P-sample, Q-sorter. Of 160 statements, 33 Q-sample statements were selected as Q-set. Then, 37 P-samples (24 men; 13 women) were recruited from a university-affiliated diabetes clinic in South Korea. Data obtained from each P-sample with a Q-set and a Q-sorting table, a forced-choice normal distribution table, were analyzed using varimax rotation. RESULTS Forty-one percent of the variance was explained with 5 factors represented by 27 Q-sorters, explaining variance ranging from 5% to 17% for each factor: Factor A (n = 6): those showing self-management education need but possessing inadequate health literacy; Factor B (n = 4): those valuing lifestyle modification to control diabetes; Factor C (n = 5): those valuing antidiabetic medication to control diabetes; Factor D (n = 6): carpe diem, accepting diabetes as destiny; and Factor E (n = 6): those overestimating their competencies to control diabetes. Ten Q-sorters fell into either confounded or nonsignificant. CONCLUSIONS Tailoring messages and educational approaches based on patients' psychological phenotypes are necessary to promote optimal self-management behaviors.
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Affiliation(s)
- EunSeok Cha
- College of Nursing, Chungnam National University, Daejeon, South Korea.,Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Myoung Hwan Shin
- School of Communication and Media, Sookmyung Women's University, Seoul, South Korea
| | - Michael Smart
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, Georgia
| | - Hyesun Jang
- College of Nursing, Chungnam National University, Daejeon, South Korea
| | - Jooseon Lee
- College of Nursing, Chungnam National University, Daejeon, South Korea
| | - Kyong Hye Joung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Hyun Jin Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Melissa Spezia Faulkner
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.,Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, Georgia
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Cha E, Pasquel FJ, Yan F, Jacobs DR, Dunbar SB, Umpierrez G, Choi Y, Shikany JM, Bancks MP, Reis JP, Spezia Faulkner M. Characteristics associated with early- vs. later-onset adult diabetes: The CARDIA study. Diabetes Res Clin Pract 2021; 182:109144. [PMID: 34774915 PMCID: PMC8688278 DOI: 10.1016/j.diabres.2021.109144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 12/21/2022]
Abstract
AIMS Differences in risk profiles for individuals with early- (<40 years old) vs. later-onset (≥40 years old) diabetes were examined. METHODS A nested case-comparison study design using 30-year longitudinal data from the Coronary Artery Risk Development in Young Adults (CARDIA) study was used. Survey data (socio-demographics, family history, medical records, and lifestyle behaviors), obesity-related measures (body mass index, weight), blood pressure, and laboratory data (insulin, fasting glucose, 2-h glucose, and lipids) were used to examine progression patterns of diabetes development in those with early-onset vs. later-onset diabetes. RESULTS Of 605 participants, 120 were in early-onset group while 485 were in later-onset group. Early-onset group had a lower A Priori Diet Quality Score, but not statistically significant at baseline; however, the between-group difference became significant at the time that diabetes was first detected (p = 0.026). The physical activity intensity score consistently decreased from baseline to the development of diabetes in both the early- and later-onset groups. Early-onset group showed more dyslipidemia at baseline and at the time that diabetes was first detected, and rapid weight gain from baseline to the development of diabetes. CONCLUSIONS Emphases on lifestyle modification and risk-based diabetes screening in asymptomatic young adults are necessary for early detection and prevention.
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Affiliation(s)
- EunSeok Cha
- College of Nursing, Chungnam National University, Daejeon, South Korea; Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, USA.
| | | | - Fengxia Yan
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, USA.
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Sandra B Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, USA
| | | | - Yuni Choi
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - James M Shikany
- Division of Preventive Medicine, School of Medicine, University of Alabama, Birmingham, AL, USA
| | - Michael P Bancks
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jared P Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Melissa Spezia Faulkner
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, USA; Byrdine F. Lewis School of Nursing and Health Professions, Georgia State University, Atlanta, USA
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Faulkner MS, Smart MJ. Sleep quality and heart rate variability in adolescents with type 1 or type 2 diabetes. J Diabetes Complications 2021; 35:108049. [PMID: 34600825 PMCID: PMC8608749 DOI: 10.1016/j.jdiacomp.2021.108049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/07/2021] [Accepted: 09/14/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Decreased sleep quality and lower heart rate variability (HRV) have both independently been associated with diabetes and may contribute to risks for cardiovascular disease. Although poor sleep quality has been associated with lower HRV in adults with type 2 diabetes (T2D), studies of sleep quality in adolescents with (T2D) or studies examining the possible association of poor sleep quality with lower HRV in adolescents with T2D or T1D are not available. AIM Thus, we conducted a secondary analysis of data from an existing study to determine if there were associations between sleep quality and HRV in adolescents with T1D or T2D. METHODS Adolescents with T1D (n = 101) or T2D (n = 37) completed 24-h HRV Holter monitoring and analysis and a self-reported global measure of sleep quality. RESULTS Poor sleep quality was significantly associated with lower HRV, a known predictor for CV risk. Those with T2D had lower measures of HRV. CONCLUSIONS The evaluation of sleep quality and early signs of cardiovascular autonomic changes should be considered in routine assessments of adolescents with diabetes. Future research is warranted to examine more robust measures of sleep and HRV in adolescents with diabetes.
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Affiliation(s)
| | - Michael J Smart
- Georgia State University, P.O. Box 4019, Atlanta, GA 30302-4019, USA.
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Marcus J, Adebayo M, Cranwell-Bruce L, Faulkner MS. Evaluating Nursing Students' Perceptions of Using Quick Response Codes to Enhance Learning During Nursing Health Assessment. Nurs Educ Perspect 2021; 42:E133-E134. [PMID: 32195791 DOI: 10.1097/01.nep.0000000000000652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Providing engaging activities to supplement classroom learning can be a challenge for today's nurse educator. Quick response (QR) code technology provides hands-on clinical experiences without the use of high-fidelity simulators. The purpose of this article is to evaluate how QR codes during a health assessment simulation activity enhanced learning for first-semester baccalaureate nursing students. The use of QR codes increased student confidence during health assessment with a form of technology they found engaging.
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Affiliation(s)
- Jessica Marcus
- About the Authors The authors are faculty at the Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, Georgia. Jessica Marcus, DNP, RN, WHNP-BC, is a clinical instructor. Modupeola Adebayo, DNP, RN, is a clinical assistant professor. Lisa Cranwell-Bruce, DNP, RN, FNP-C, is a clinical associate professor. Melissa Spezia Faulkner, PhD, RN, FAAN, a professor, is the Lewis Distinguished Chair in Nursing. For more information, contact Dr. Marcus at
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Faulkner MS, Michaliszyn SF. Exercise Adherence in Hispanic Adolescents with Obesity or Type 2 Diabetes. J Pediatr Nurs 2021; 56:7-12. [PMID: 33181374 PMCID: PMC7855355 DOI: 10.1016/j.pedn.2020.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/12/2020] [Accepted: 09/15/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Hispanic adolescents experience high rates of obesity and type 2 diabetes. The purpose of this study was to examine adherence to a 16-week personalized exercise intervention and the perception of family support for exercise, benefits and barriers to exercise and overall health in Hispanic adolescents diagnosed with obesity or type 2 diabetes. DESIGN AND METHODS Using a secondary analysis of a larger feasibility trial, data from 21 Hispanic adolescents, 13 with T2D and 8 who were obese and 14 that completed the entire 16-week study (7 T2D; 7 obese) were analyzed. Adolescents wore an Actigraph™ accelerometer for tracking exercise throughout the 16-week intervention. RESULTS The adherence rate for the intervention was 59% for those with T2D and was 88% for those with obesity. Overall perceptions of health improved for those completing the 16-week intervention. Barriers to exercise were negatively associated with moderate-to-vigorous physical activity and were higher in those with T2D. CONCLUSIONS Adolescents with T2D were less adherent to their personalized exercise program than those who were obese. PRACTICE IMPLICATIONS Strategies that address cultural preferences and family engagement are needed to address barriers to exercise for Hispanic youth, particularly those already diagnosed with T2D that have high risks for early onset of disease complications.
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Affiliation(s)
- Melissa Spezia Faulkner
- Professor and Lewis Distinguished Chair in Nursing, Byrdine F. Lewis College of Nursing and Health Professions, Atlanta, United States of America.
| | - Sara Fleet Michaliszyn
- Associate Professor and Department Chair, Department of Kinesiology and Sport Science, OH, United States of America
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Faulkner MS, Quinn L, Fritschi C, Tripp N, Hayat MJ. Heart Rate Variability and Cardiorespiratory Fitness in Non-Hispanic Black Versus Non-Hispanic White Adolescents With Type 1 Diabetes. J Cardiovasc Nurs 2020; 34:372-379. [PMID: 31343621 PMCID: PMC6690789 DOI: 10.1097/jcn.0000000000000590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Evidence indicates that fewer non-Hispanic black versus non-Hispanic white youths with type 1 diabetes are meeting treatment goals for optimal glycemic outcomes, predisposing them to risks for cardiovascular (CV) morbidity and mortality in adulthood. PURPOSE We sought to assess the association of sex and race with heart rate variability (HRV) and cardiorespiratory fitness in adolescents with type 1 diabetes. The association between the HRV and cardiorespiratory outcomes with glucose control was also examined. METHODS A secondary data analysis of 95 adolescents with type 1 diabetes (n = 66 non-Hispanic white n = 29 non-Hispanic black) was used. Using 24-hour Holter recordings, spectral and time domain measures of HRV were obtained. Cardiorespiratory fitness using a graded exercise test was completed. Descriptive statistics and Pearson correlation coefficients were used to assess associations between glucose control and study outcomes, and general linear models were applied to explore and quantify associations of sex and race with HRV and cardiorespiratory fitness. RESULTS Body mass index (mean [standard deviation]) was similar between non-Hispanic black (23.5 [3.9]) and non-Hispanic white (22.7 [3.8]) adolescents. Females and non-Hispanic black adolescents had significantly lower HRV and cardiorespiratory fitness levels. Moderate associations were found between lower HRV and poorer glycemic control (HbA1c). Recent HbA1c was significantly higher in non-Hispanic black (9.7 [1.8]) than non-Hispanic white (8.2 [1.2]). CONCLUSION Findings support the importance of early identification of CV health risks in adolescents with type 1 diabetes, particularly for non-Hispanic black adolescents. Interventions focused on overall improvement in glycemic control for adolescents with type 1 diabetes are a priority for minimizing future CV complications.
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Affiliation(s)
| | - Laurie Quinn
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago
| | - Cynthia Fritschi
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago
| | - Natalie Tripp
- Department of Population Health Sciences, School of Public Health, Georgia State Univesity
| | - Matthew J. Hayat
- Department of Population Health Sciences, School of Public Health, Georgia State Univesity
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Abstract
ABSTRACT Routine tracheostomy care in children maintains airway patency, minimizes infection, and ensures skin integrity around the tracheostomy stoma to prevent complications. Using evidence-based recommendations for care of the mature tracheostomy limits variation in practice and leads to better patient outcomes in all care settings. Incorporating evidence-based care into practice is especially important because children with tracheostomies are at high risk for morbidity and mortality. The purpose of this review is to summarize the most current, evidence-based literature for pediatric tracheostomy care, including stoma care and tracheostomy suctioning. Rehabilitation nurses can then include these best practices when caring for children with tracheostomies and when educating caregivers who provide tracheostomy care to children at home.
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Affiliation(s)
- Patricia R Lawrence
- Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA
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Wolf RA, Haw JS, Paul S, Spezia Faulkner M, Cha E, Findley MK, Khan F, Markley Webster S, Alexopoulos AS, Mehta K, Alfa DA, Ali MK. Hospital admissions for hyperglycemic emergencies in young adults at an inner-city hospital. Diabetes Res Clin Pract 2019; 157:107869. [PMID: 31560962 PMCID: PMC6914263 DOI: 10.1016/j.diabres.2019.107869] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/18/2019] [Accepted: 09/23/2019] [Indexed: 12/16/2022]
Abstract
AIMS There is limited information characterizing young adults (18-35 years) (YA) with diabetes, especially those admitted for hyperglycemic emergencies. The study aims were to examine associations of patient-level characteristics with hyperglycemic emergency hospitalization and to identify variations based on diabetes type and glycemic control. METHODS We conducted retrospective analysis of 273 YA admitted to an inner-city hospital with diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic nonketotic syndrome (HHS). T-tests, Chi-Square tests, and ANOVA identified differences in demographics, diabetes history, clinical indicators, complications/comorbidities, and hospital admission stratified separately by diabetes type (1 vs 2) and admission HbA1c < 9% (75 mmol/mol), ≥9% to 12% (108 mmol/mol), ≥12%). RESULTS Mean admission HbA1c was 12.4% (112 mmol/ml). HbA1c was ≥9.0% for 90.5%. The main DKA/HHS trigger was medication nonadherence (57.9%), with 35.6% presenting with new-onset type 2 diabetes. Only 3.7% utilized outpatient diabetes clinics, 38.8% were re-hospitalized within the year, and 69% lacked insurance. Diabetes complications (44.7%) and psychiatric co-morbidities (35.5%) were common. Significantly more YA with type 1 diabetes had insurance, whereas YA with type 2 diabetes had higher admission HbA1c. YA with HbA1c ≥12% were more likely to be Black and lack insurance. CONCLUSIONS YA hospitalized for DKA/HHS in an inner-city hospital tended to have severely uncontrolled diabetes. Many already had comorbidities and diabetes complications, high use of acute care services and low use of diabetes specialty services. YA characteristics varied by diabetes type and HbA1c. Overall, a substantial percentage lacked insurance, potentially impacting healthcare utilization patterns and medication adherence, and leading to DKA/HHS admissions.
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Affiliation(s)
- Rachel A Wolf
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States.
| | - J Sonya Haw
- School of Medicine, Emory University, Atlanta, GA, United States
| | - Sudeshna Paul
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - Melissa Spezia Faulkner
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States; School of Nursing, Georgia State University, Atlanta, GA, United States
| | - EunSeok Cha
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States; Chungnam National University, College of Nursing, Daejeon, South Korea
| | - M K Findley
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - Farah Khan
- School of Medicine, Emory University, Atlanta, GA, United States; Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, United States
| | | | | | - Komal Mehta
- School of Medicine, Emory University, Atlanta, GA, United States
| | - David A Alfa
- School of Medicine, Emory University, Atlanta, GA, United States
| | - Mohammed K Ali
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States; Rollins School of Public Health, Emory University, Atlanta, GA, United States
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15
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Spratling R, Spezia Faulkner M, Feinberg I, Hayat MJ. Creating opportunities for personal empowerment: Symptom and technology management resources (COPE-STAR) for caregivers of children who require medical technology. J Adv Nurs 2019; 76:347-355. [PMID: 31612518 DOI: 10.1111/jan.14235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 09/27/2019] [Accepted: 10/02/2019] [Indexed: 12/25/2022]
Abstract
AIM This research protocol addresses the development of web-based modules for the 'creating opportunities for personal empowerment: symptom and technology management resources' intervention with caregivers of children who require medical technology. The commonly experienced symptoms of fever and increased respiratory symptoms (coughing, wheezing, increased secretions), and the care of technologies (tracheostomy tubes, respiratory equipment and feeding tubes) are addressed in this nurse-led and nurse-developed intervention. DESIGN The purpose of this study was to develop web-based intervention modules and obtain review by expert and caregiver reviewers using a systematic, structured process and form. METHODS The intervention includes evidenced-based, theory-based, modules that address the child's most common emotions and behavioural responses with the management of their symptoms and technologies using a web-based format. To establish fidelity of the intervention, expert and caregiver reviewers (e.g. caregivers of children with multiple complex chronic illnesses and technologies) will review the modules that will then be refined prior to feasibility testing. Funding for the study began in July 2018. DISCUSSION The intervention development led by nurses entails an evidence-based literature review; development of scripts with appropriate health literacy level; and content by experts, photography, and videography; production of video modules and creation of a website for modules. IMPACT This nursing intervention addresses the educational needs and skills considered essential and most applicable to caregivers of children who require medical technology to improve self-management of their child's symptoms and technology in the home setting. The information obtained from this study will be valuable to nursing, other healthcare providers and healthcare systems in planning and implementing programs and services for these children and for nurse researchers designing intervention studies for children with multiple complex chronic illnesses. TRIAL REGISTRATION This study is not designated as a clinical trial per NIH/NINR study and grant proposal guidelines.
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Affiliation(s)
- Regena Spratling
- School of Nursing, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA
| | - Melissa Spezia Faulkner
- School of Nursing, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, GA, USA
| | - Iris Feinberg
- Adult Literacy Research Center, College of Education and Human Development, Georgia State University, Atlanta, GA, USA
| | - Matthew J Hayat
- Biostatistics, Department of Population Health Sciences, School of Public Health, Byrdine F. Lewis College of Nursing & Health Professions (Joint), Georgia State University, Atlanta, GA, USA
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16
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Michaliszyn SF, Higgins M, Faulkner MS. Patterns of Physical Activity Adherence by Adolescents With Diabetes or Obesity Enrolled in a Personalized Community-Based Intervention. Diabetes Educ 2018; 44:519-530. [PMID: 30306834 PMCID: PMC10826413 DOI: 10.1177/0145721718805693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to determine the feasibility of a personalized, 16-week community-based physical activity intervention for adolescents with diabetes or obesity and examine the weekly patterns of adherence to the intervention. METHODS Physical activity adherence was evaluated throughout the intervention using accelerometers in 46 adolescents with type 1 diabetes (N = 22), type 2 diabetes (N = 12), or obesity (N = 12) (age, 14.4 ± 1.5 years; 56.5% female; 61% Hispanic). Of these, 39 completed the intervention, and 7 did not. RESULTS There were no differences in baseline anthropometric characteristics or fitness between the completers versus noncompleters. Completers began above 1060 metabolic equivalent (MET) min/wk-1and stayed above 900 MET min/wk-1 for ~4 weeks and declined 39 MET min/wk-1 until end of study. Noncompleters began at 924 MET min/wk-1 yet dropped below 800 MET min/wk-1 by end of week 1 and declined an average of 151 MET min/wk-1. Interestingly, self-report of barriers to activity were higher in completers versus noncompleters. CONCLUSIONS Findings highlight that adolescents completing the intervention could sustain a prescribed level of personalized activity for at least 1 month but had steadfast declines in weekly activity. Even with individualized programs, factors other than barriers to activity need to be considered when designing approaches to physical activity adherence for adolescents with diabetes or obesity.
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Affiliation(s)
- Sara F Michaliszyn
- Department of Kinesiology and Sport Science, Youngstown State University, Youngstown, Ohio
| | - Melinda Higgins
- Office of Nursing Research, Emory University, Atlanta, Georgia
| | - Melissa Spezia Faulkner
- Byrdine F. Lewis College of Nursing & Health Professions, Georgia State University, Atlanta, Georgia
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17
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Cha E, Paul S, Braxter BJ, Umpierrez G, Faulkner MS. Dietary Behaviors and Glucose Metabolism in Young Adults at Risk for Type 2 Diabetes. Diabetes Educ 2018; 44:158-167. [PMID: 29495910 DOI: 10.1177/0145721718756057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Purpose The purpose of the study was to examine the associations between dietary behaviors and glucose metabolism in high-risk young adults to increase the precision of nutrition education to prevent early onset type 2 diabetes (T2D). Method Using a descriptive, cross-sectional study design, 106 overweight or obese sedentary young adults ages 18-29 years from the Atlanta metropolitan area were recruited to screen diabetes risk. Survey questionnaires, anthropometric assessment, blood pressure (BP), and laboratory data were collected in a clinical research unit. The Web-based HOMA2 calculator was used to calculate beta cell function and insulin sensitivity. Results The final sample included 103 participants. There were similar patterns of diet (caloric intake and dietary quality) between African Americans and non-African Americans, whereas African Americans showed hyperinsulinemia compared with non-African Americans. When young adults consumed a good quality diet (appropriate carbohydrate intakes; high fiber, low saturated fat but protein rich diet), their insulin resistance was decreased. There was a marginal interaction effect between insulin sensitivity and beta cell function by race. Systolic BP was higher in African Americans, and total cholesterol, triglycerides, and low-density lipoprotein cholesterol were higher in non-African Americans. Conclusion Findings are useful to develop age-specific nutrition guidelines to prevent early onset T2D in high-risk young adults.
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Affiliation(s)
- EunSeok Cha
- College of Nursing, Chungnam National University, Daejeon, South Korea.,Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Sudeshna Paul
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Betty J Braxter
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Melissa Spezia Faulkner
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.,Byrdine F. Lewis School of Nursing and Health Professions, Georgia State University, Atlanta, Georgia
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18
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Betz CL, Cowell JM, Faulkner MS, Feeg VD, Greenberg CS, Krajicek MJ, Lipman TH, Lobo ML, Nehring WM, Craft-Rosenberg M, Vessey JA. Advancing the Development of the Guidelines for the Nursing of Children, Adolescents, and Families: 2014 Revision: Process, Development, and Dissemination. J Pediatr Health Care 2016; 30:284-8. [PMID: 26700164 DOI: 10.1016/j.pedhc.2015.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/01/2015] [Accepted: 11/10/2015] [Indexed: 10/22/2022]
Abstract
This article details the process used to develop the revision of the original Guidelines that resulted in the development of the 2014 Health Care Quality and Outcomes Guidelines for Nursing of Children, Adolescents, and Families. Members of the 2014 Guidelines Revision Task Force conducted an extensive process of revision, which included the input and approval of 16 pediatric and child health nursing and affiliated organizational endorsements. The revised Guidelines were presented to and endorsed by the American Academy of Nursing Board. These Guidelines are designed for use by pediatric and child health nurses who work in a range of health care and community-based settings. The Guidelines are proposed to be used as a framework for nurse-directed services and intervention development and testing, as a model for undergraduate and graduate pediatric and child health nursing program curriculum development, and as the theoretical basis for nursing investigations on the care of children, adolescents, and families.
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19
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Han Y, Faulkner MS, Fritz H, Fadoju D, Muir A, Abowd GD, Head L, Arriaga RI. A Pilot Randomized Trial of Text-Messaging for Symptom Awareness and Diabetes Knowledge in Adolescents With Type 1 Diabetes. J Pediatr Nurs 2015; 30:850-61. [PMID: 25720675 PMCID: PMC4546930 DOI: 10.1016/j.pedn.2015.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 02/03/2015] [Accepted: 02/04/2015] [Indexed: 11/21/2022]
Abstract
Adolescents with type 1 diabetes typically receive clinical care every 3 months. Between visits, diabetes-related issues may not be frequently reflected, learned, and documented by the patients, limiting their self-awareness and knowledge about their condition. We designed a text-messaging system to help resolve this problem. In a pilot, randomized controlled trial with 30 adolescents, we examined the effect of text messages about symptom awareness and diabetes knowledge on glucose control and quality of life. The intervention group that received more text messages between visits had significant improvements in quality of life.
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Affiliation(s)
- Yi Han
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA
| | | | | | - Doris Fadoju
- Emory University School of Medicine, Atlanta, GA
| | - Andrew Muir
- Emory University School of Medicine, Atlanta, GA
| | - Gregory D Abowd
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA
| | - Lauren Head
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | - Rosa I Arriaga
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA
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Cha E, Braxter BJ, Kim KH, Lee H, Akazawa MK, Talman MS, Pinto MD, Faulkner MS. Preventive strategies to reduce depressive symptoms in overweight and obese young adults. Arch Psychiatr Nurs 2015; 29:258-64. [PMID: 26397427 PMCID: PMC4580911 DOI: 10.1016/j.apnu.2015.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 11/23/2014] [Accepted: 04/11/2015] [Indexed: 11/17/2022]
Abstract
This study examined the relationships among problem-solving, physical activity self-efficacy, leisure-time physical activity, and depressive symptoms in overweight/obese young adults vulnerable to many health risks. Data from 96 young adults were used. The mean age and body mass index were 24.0±3.3 years old, and 36.9±7.9, respectively. There was a positive association between physical activity self-efficacy and leisure-time physical activity in African Americans, but not in non-African Americans. Better problem solving was associated with fewer depressive symptoms regardless of gender and race.
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Affiliation(s)
- EunSeok Cha
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA.
| | | | - Kevin H Kim
- University of Pittsburgh School of Education, Pittsburgh, PA
| | - Heeyoung Lee
- University of Pittsburgh School of Nursing, Pittsburgh, PA
| | | | | | - Melissa D Pinto
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA
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21
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Findley MK, Cha E, Wong E, Faulkner MS. A Systematic Review of Transitional Care for Emerging Adults with Diabetes. J Pediatr Nurs 2015; 30:e47-62. [PMID: 26164412 PMCID: PMC4567467 DOI: 10.1016/j.pedn.2015.05.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 05/28/2015] [Accepted: 05/31/2015] [Indexed: 01/17/2023]
Abstract
The prevalence of diabetes and prediabetes in adolescents is increasing. A systematic review of 31 research articles focusing on transitional care for adolescents or emerging adults with diabetes or prediabetes was completed. Studies focused on those with type 1 diabetes, not type 2 diabetes or prediabetes, and were primarily descriptive. Major findings and conclusions include differences in pediatric versus adult care delivery and the importance of structured transitional programs using established recommendations of leading national organizations. Implications include future research on program development, implementation, and evaluation that is inclusive of adolescents and emerging adults, regardless of diabetes type, or prediabetes.
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Affiliation(s)
- Mary K. Findley
- Correspondence concerning this article should be addressed to MK Findley. Emory University Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road NE Atlanta, GA 30322-4201, Phone: 404-712-9693 Fax: 404-727-9382,
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22
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Downs CA, Faulkner MS. Toxic stress, inflammation and symptomatology of chronic complications in diabetes. World J Diabetes 2015; 6:554-565. [PMID: 25987953 PMCID: PMC4434076 DOI: 10.4239/wjd.v6.i4.554] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 12/30/2014] [Accepted: 02/12/2015] [Indexed: 02/05/2023] Open
Abstract
Diabetes affects at least 382 million people worldwide and the incidence is expected to reach 592 million by 2035. The incidence of diabetes in youth is skyrocketing as evidenced by a 21% increase in type 1 diabetes and a 30.5% increase in type 2 diabetes in the United States between 2001 and 2009. The effects of toxic stress, the culmination of biological and environmental interactions, on the development of diabetes complications is gaining attention. Stress impacts the hypothalamus-pituitary-adrenal axis and contributes to inflammation, a key biological contributor to the pathogenesis of diabetes and its associated complications. This review provides an overview of common diabetic complications such as neuropathy, cognitive decline, depression, nephropathy and cardiovascular disease. The review also provides a discussion of the role of inflammation and stress in the development and progression of chronic complications of diabetes, associated symptomatology and importance of early identification of symptoms of depression, fatigue, exercise intolerance and pain.
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Withycombe JS, Smith LM, Meza JL, Merkle C, Faulkner MS, Ritter L, Seibel NL, Moore K. Weight change during childhood acute lymphoblastic leukemia induction therapy predicts obesity: a report from the Children's Oncology Group. Pediatr Blood Cancer 2015; 62:434-9. [PMID: 25407299 PMCID: PMC4304977 DOI: 10.1002/pbc.25316] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 09/22/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Obesity is a well documented problem associated with childhood acute lymphoblastic leukemia (ALL) with increasing body mass index often observed during therapy. This study aims to evaluate if weight gain, early in therapy, is predictive of obesity at the end of treatment. PROCEDURE In this secondary analysis, data from 1,017 high-risk ALL patients previously treated on a Children's Oncology Group protocol (CCG study 1961) were reviewed. Logistic regression was used to examine whether change in BMI z-score at Induction or Delayed Intensification (DI) 1 were predictive of obesity at the end of therapy. RESULTS The BMI z-score at the beginning of Induction and the change in BMI z-score during Induction were both significant predictors of obesity at the end of therapy. The change in BMI z-score during cycle 1 of DI was not found to be associated with obesity. CONCLUSIONS It is well know that obesity at the beginning of therapy is predictive of obesity at the end of ALL therapy. The new, and more important, finding from this study is that even after adjusting for baseline weight, the increase in BMI z-scores during induction was an independent predictor of obesity at the end of therapy. Most researchers agree that prevention is the best form of treatment for obesity as it is difficult to reverse once it is present. This study suggests that monitoring weight trends during Induction may be useful in guiding healthcare practitioners in identifying which patients are at highest risk for obesity development so that early intervention may occur.
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Affiliation(s)
- Janice S. Withycombe
- Children’s Cancer Center, Palmetto Health, Columbia, SC,Correspondence to: Janice S. Withycombe, Palmetto Health, Children’s Cancer Center, 9 Richland Medical Park Drive, Suite 400, Columbia, South Carolina, 29203. Tel.: (803) 434-3505, Fax: (803) 434-3094,
| | - Lynette M. Smith
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska
| | - Jane L. Meza
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska
| | - Carrie Merkle
- College of Nursing, University of Arizona, Tucson, Arizona
| | | | - Leslie Ritter
- College of Nursing, University of Arizona, Tucson, Arizona
| | - Nita L. Seibel
- National Cancer Institute, Bethesda, Maryland,Children’s National Medical Center, Washington, DC
| | - Ki Moore
- College of Nursing, University of Arizona, Tucson, Arizona
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Abstract
OBJECTIVE This study examined adherence to a personalized, community-based exercise intervention by sedentary adolescents with type 1 or type 2 diabetes or those with obesity. RESEARCH DESIGN AND METHODS We conducted a pretest-posttest investigation to explore the application of an individualized exercise prescription based upon current fitness level for 39 adolescents (20 with type 1 diabetes, 9 with type 2 diabetes, and 10 obese) over 16 weeks in community settings. Subjects were recruited from a university-based pediatric endocrinology clinic in the southwestern United States. Adherence to the exercise prescription was monitored using accelerometers over the entire intervention period. RESULTS Moderate-to-vigorous physical activity (MVPA) levels significantly increased over sedentary baseline values (p < .001), but the average of 42.5 ± 22.1 min/day of MVPA determined at the end of the study was still less than the recommended 60 min/day. Perceptions of health were significantly increased for the total group following the intervention (p = .008). For those with type 1 diabetes, there was a significant association between MVPA duration and percentage change in HbA1c (r = -.526, p = .02). CONCLUSIONS Recruitment and retention of adolescent participation in daily exercise is challenging. Personalized approaches that include adolescent choices with family support and ongoing motivation can improve individual exercise adherence and a sense of personal health.
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Abstract
PURPOSE Limited information on intervention fidelity is available in published studies with youth and families. The components of intervention fidelity, the complexity of measurement in these studies, and strategies for measuring intervention fidelity are described. CONCLUSIONS Strategies for ensuring intervention fidelity according to the Treatment Fidelity Workgroup of the Behavior Change Consortium in the areas of study design, provider training, treatment delivery, treatment receipt, and treatment enactment provide guidance for evaluating or developing intervention fidelity plans. PRACTICE IMPLICATIONS Ensuring the quality of intervention fidelity in evidence-based reviews or when developing new interventions is essential for translating findings into practice.
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26
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Abstract
The purpose of this study was to describe the associations between levels of physical activity measured by accelerometry and changes in fitness, body composition, lipids, and glucose control (i.e., glycosolated hemoglobin [A1C]) in a sample of 16 adolescents with type 1 diabetes participating in a personalized exercise program. More sedentary activity was associated with lower fitness and fat free mass and increased total cholesterol, low-density lipoprotein (LDL-c), and triglycerides (p < .05). Greater amounts of moderate to vigorous activity were associated with higher fitness and fat free mass, and decreased total cholesterol, LDL-c, triglycerides, and A1C (p < .05). Findings support the beneficial effects of increased moderate activity and decreased sedentary behavior to reduce cardiovascular risks and improve glucose control in adolescents with type 1 diabetes.
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Abstract
PURPOSE This descriptive study of adolescents with type 1 or type 2 diabetes examined the relationships between cardiovascular fitness and physical activity (PA) with generic or health-related quality of life (QoL), glycemic control, and lipids. DESIGN AND METHODS Graded ergometry testing for fitness, fasting assays for lipids, glycosylated hemoglobin (A1C), and self-reported PA and QoL instruments were completed with 151 adolescents. RESULTS Adolescents with type 2 diabetes had lower fitness. Fitness was associated with improved lipids, A1C, health perception, and athletic competence in adolescents with type 1 diabetes. PRACTICE IMPLICATIONS Interventions to encourage active lifestyles are imperative for adolescents with diabetes.
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Affiliation(s)
- Melissa Spezia Faulkner
- Diabetes Research and Education, University of Arizona, College of Nursing, Tucson, Arizona, USA.
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28
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Abstract
PURPOSE This exploratory study tested the feasibility of conducting a novel, personalized exercise intervention based upon the current fitness levels of adolescents with type 1 diabetes (T1DM). The relationships of perceptions of benefits and barriers to exercise, exercise self-efficacy and family support to exercise adherence and changes in cardiovascular (CV) fitness, quality of life (QOL), and glycemic control were studied. METHODS Adolescents who were sedentary received a graded exercise test to determine their current fitness level (VO(2peak)). A 16-wk personalized exercise program was developed for each adolescent based upon individual fitness level and exercise preferences. Pretest and posttest measures of exercise self-efficacy, benefits and barriers to exercise, family support, and diabetes QOL were completed. A1c levels were obtained using the DCA2000. Adherence to exercise was measured using the Actigraph Accelerometer. RESULTS Twelve adolescents completed the study. Accelerometry data revealed adherence to 60 min of moderate-to-vigorous physical activity (MVPA) per day for a mean of 45.5 (SD = 23.9)% of the days the accelerometer was worn. Adolescents' perceptions of family support for exercise improved following the intervention (p = 0.03). Adolescents who had more daily bouts of exercise lasting 60 min increased their CV fitness (r = 0.59, p = 0.04). A1c remained unchanged. CONCLUSIONS Encouraging 60 min of accumulated exercise bouts/d can improve fitness levels in adolescents with T1DM, minimizing future CV risks. Although physical activity increased in adolescents, family based strategies are required to promote current physical activity recommendations.
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Affiliation(s)
- Melissa Spezia Faulkner
- College of Nursing, University of Arizona, 1305 N. Martin Avenue, P. O. Box 210203, Tucson, AZ 85721-0203, USA.
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Spezia Faulkner M, Fritschi C, Quinn L, Hepworth JT. Cardiovascular Risks in Adolescents With Diabetes From Vulnerable Populations. Home Health Care Management & Practice 2010. [DOI: 10.1177/1084822309343944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Limited data exist on the predisposition for an early trajectory of cardiovascular (CV) disease in adolescents with diabetes. We explored the effects of types of diabetes and sociodemographic factors (i.e., race, gender, income level, family structure) on the following CV risks: glucose control (A1c), blood pressure (BP), and lipid profile. Adolescents with type 1 DM (T1DM) or type 2 DM (T2DM) participated: 109 with T1DM and 42 with T2DM. The general linear model was used to examine the influence of type of DM, sociodemographic factors, and the interaction of type of DM and the sociodemographic factors on CV risks. Systolic and diastolic BP were increased in youth with T2DM versus T1DM. Non-Hispanic Blacks had a higher A1c and resting diastolic BP than non-Hispanic Whites. Lower income was also associated with higher resting diastolic BP. Males with T1DM had higher A1c, whereas females with T2DM had higher A1c. With low income, individuals with T1DM had higher A1c values than those with T2DM; those with high income and T2DM had higher A1c than those with T1DM. Adolescents with T1DM from single, divorced, or separated families had higher average A1c values. In comparison, those with T2DM from married families had higher A1c values. Triglycerides were increased for those with T2DM, with the greatest amount for Hispanics as compared with non-Hispanic Blacks. In summary, minority status, lower income, and family structure may have a greater impact on vulnerability for poor outcomes in adolescents with DM, regardless of the type of the disease.
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Affiliation(s)
| | | | - Lauretta Quinn
- College of Nursing, University of Illinois at Chicago, IL, USA
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Shaibi GQ, Michaliszyn SB, Fritschi C, Quinn L, Faulkner MS. Type 2 diabetes in youth: a phenotype of poor cardiorespiratory fitness and low physical activity. ACTA ACUST UNITED AC 2010; 4:332-7. [PMID: 19922049 DOI: 10.3109/17477160902923341] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The increased incidence of obesity and type 2 diabetes (T2D) among youth has prompted the development of guidelines for healthy cardiorespiratory fitness (CRF) and physical activity (PA) levels in the pediatric population. It is unclear whether youth with T2D meet these guidelines as previous research has not included type 2 diabetics. Therefore, the purpose of this investigation was to examine CRF and PA in youth with T2D and compare these results with recently published normative data for CRF and guidelines for PA in youth. METHODS. Forty adolescents (17 males and 23 females) with T2D were assessed for moderate-to-vigorous PA via the 7-day PA recall. CRF was determined by a progressive cycle ergometer test and indirect calorimetry. PA levels were compared with recently published guidelines for youth of 60 minutes per day, and CRF data were compared with age- and sex-adjusted normative values from the National Health and Nutrition Examination Survey 1999-2002. Results. Only 17.6% (3/17) of boys and 21.7% (5/23) of girls met PA guidelines, while none of the participants met criteria for healthy CRF. When compared with normative CRF data for US youth, approximately 93% of boys and 95% of girls scored below the 10th percentile. CONCLUSIONS These results suggest that youth with T2D exhibit low levels of CRF and the majority do not participate in recommended amounts of PA. Practitioners working with type 2 diabetic youth need to emphasize the importance of regular PA to increase CRF and promote cardiovascular health in an effort to decrease long-term diabetes-related complications.
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Affiliation(s)
- Gabriel Q Shaibi
- Consortium for Obesity-Related Health Disparities Research and Action, College of Nursing & Healthcare Innovation and the Department of Kinesiology, Arizona State University, AZ 85004, USA.
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Faulkner MS, Quinn L, Fritschi C. Microalbuminuria and heart rate variability in adolescents with diabetes. J Pediatr Health Care 2010; 24:34-41. [PMID: 20122476 PMCID: PMC2819478 DOI: 10.1016/j.pedhc.2009.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2008] [Revised: 12/20/2008] [Accepted: 01/10/2009] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Limited clinical and research data are available on early renal and cardiovascular complications in youth with diabetes. The possible associations of elevated microalbuminuria to creatinine (MC) ratios with heart rate variability (HRV) were explored in adolescents with type 1 (T1DM) or type 2 (T2DM) diabetes. METHODS A descriptive study was conducted with 41 adolescents with diabetes (n = 31 T1DM vs. n = 10 T2DM). Twenty-four hour Holter recordings for determining HRV, urine spot checks for MC ratio, and the most recent measures of glycosylated hemoglobin (A1c) were obtained. RESULTS HRV was significantly lower in the T2DM group, while body mass index percentile, triglycerides, and diastolic blood pressure were significantly higher. For the T1DM group, clinical case examples provided evidence of elevated MC ratios (>30 mirog/mg) occurring in two female subjects who also had decreased HRV measures. DISCUSSION Although HRV was not significantly associated with MC ratios for the sample, individual clinical findings can be a warning sign for some adolescents with diabetes. Current recommendations for screening of early renal complications and associated treatment are provided.
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Affiliation(s)
- Melissa Spezia Faulkner
- Diabetes Research and Education, College of Nursing, University of Arizona, P.O. Box 210203, Tucson, AZ 5721-0203, USA.
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Abstract
PURPOSE We examined whether physical fitness and dietary intake predicted better glycemic control and lipid profile in adolescents with type 1 diabetes mellitus (T1DM). METHODS The sample consisted of 109 adolescents with T1DM [age, 15.3 +/- 1.9 yr; diabetes duration, 6.2 +/- 3.7 yr; body mass index (BMI), 23.3 +/- 4.0 kg/m(2); and hemoglobin A1c (HbA1c), 8.7 +/- 1.6%]. Stepwise regression analyses were performed with the following independent variables: age, sex, duration of diabetes, BMI, Tanner stage, physical fitness, and average carbohydrate and total and saturated fat intake, and the following dependent variables: total cholesterol, low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), triglycerides, and HbA1c. Physical fitness was measured by peak oxygen consumption (VO(2(peak))) during progressive cycle ergometry, and 3-day food intake was analyzed using Nutritionist Pro software. RESULTS Sex and VO(2(peak)) explained 19% of the variance for HbA1c. Age, VO(2(peak)), and saturated fat intake predicted 23% of the variance for total cholesterol, although only diabetes duration and saturated fat intake predicted LDL-c (11%). Duration of diabetes explained 5% of the variance in triglyceride levels, and there were no significant independent predictors for HDL-c. CONCLUSIONS Greater fitness levels predicted both better glycemic control and total cholesterol in adolescents with T1DM, whereas lower saturated fat affected total cholesterol but not glycemic control. These findings support the importance of physical fitness and diets of lower saturated fat for overall metabolic health in adolescents with T1DM.
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Affiliation(s)
| | - Gabriel Q. Shaibi
- Arizona State University, College of Nursing & Healthcare Innovation, 500 N 3rd Street, Phoenix, AZ 85004-0698
| | - Lauretta Quinn
- University of Illinois at Chicago, College of Nursing, 845 South Damen Avenue, Chicago, IL 60612-7350
| | - Cynthia Fritschi
- University of Illinois at Chicago, College of Nursing, 845 South Damen Avenue, Chicago, IL 60612-7350
| | - Melissa Spezia Faulkner
- University of Arizona, College of Nursing, 1305 N. Martin, P.O. Box 210203, Tucson, AZ 85721-0203
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Faulkner MS, Michaliszyn SF, Going S, Contreras O, Romney K. The Effects Of A Personalized Aerobic Exercise Program In Obese Adolescents: An Early Adherence Study. Med Sci Sports Exerc 2009. [DOI: 10.1249/01.mss.0000355105.20666.ef] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
PURPOSE This study seeks to determine differences in key characteristics between adolescents with type 1 diabetes who experience the adverse outcomes of poor glycemic control, hypoglycemic events, and hospitalizations due to their disease versus those who do not experience such events. A secondary purpose is to examine differences in outcomes for adolescents using insulin pumps versus daily insulin injections (>or=2). METHODS Data from 108 adolescents were divided according to glycemic control (HbA1c <8% vs >or=8%), hypoglycemic reactions and hospitalizations in the past year (0 vs >or=1 episode of each), and pump versus injection delivery of insulin. Within each grouping, body mass index, insulin dose, caloric intake, parental educational level, marital status, annual family income, race, and gender were compared. HbA1c level was examined in relation to the number of hypoglycemic reactions and hospitalizations in the past year and for any differences between those receiving insulin via pump therapy versus daily injections (>or=2). RESULTS Subjects receiving insulin via pump had better glucose control and were on lower insulin doses. Subjects with adequate glucose control used a lower insulin dose, checked blood glucose levels more frequently, and had fathers with a higher education level. Those with inadequate control were more likely to come from a single-parent home, a lower-income family, and an ethnic minority. CONCLUSIONS Pump therapy for adolescents should be encouraged when appropriate. Also, certain groups of adolescents need increased supervision to manage their disease appropriately. Further research needs to explore what interventions will bring more favorable outcomes for such groups.
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Affiliation(s)
- Carla Johns
- University of Illinois at Chicago, College of Nursing, USA
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Abstract
This study explored the influence of family behaviors on self-care, quality of life (QoL), and metabolic control in school-age children and adolescents with type 1 diabetes. Ninety-nine participants were recruited in the midsouth from a health science center and an affiliated diabetes camp. Warm and caring family behaviors predicted self-care behaviors and aspects of QoL for the participants. African American school-age children and adolescents had more worries related to diabetes and had poorer metabolic control than Caucasians. Nursing implications included emphasizing open family communication and providing emotional support for diabetes management to promote developmentally appropriate levels of self-care and QoL.
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Affiliation(s)
- Melissa Spezia Faulkner
- University of Illinois at Chicago, College of Nursing, Department of Medical-Surgical Nursing, Chicago, IL 60612, USA.
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Faulkner MS, Chao WH, Kamath SK, Quinn L, Fritschi C, Maggiore JA, Williams RH, Reynolds RD. Total homocysteine, diet, and lipid profiles in type 1 and type 2 diabetic and nondiabetic adolescents. J Cardiovasc Nurs 2006; 21:47-55. [PMID: 16407737 PMCID: PMC2276696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND AND RESEARCH OBJECTIVE Limited research is available on the possible differences in the cardiovascular risk factors of total homocysteine (tHcy), dietary energy, and lipids among adolescents with type 1 diabetes mellitus (DM), type 2 DM, or healthy controls. This study's primary aim was to compare the dietary energy and the intake of macronutrients and micronutrients of folate, and vitamins B6 and B12, as well as lipids and tHcy for adolescents with type 1 DM, type 2 DM, and healthy non-DM controls. SUBJECTS AND METHODS This secondary analysis of the merging of 2 datasets included the following adolescents: 50 with type 1 DM, 14 with type 2 DM, and 53 controls. Mean ages for those with type 1 versus type 2 DM were 15.2 +/- 1.9 versus 16.1 +/- 1.9 years, respectively. Mean age for the controls was 16.5 +/- 1.0 years. Variables included fasting tHcy and lipids, and 24-hour dietary recalls for macronutrients and micronutrients. Hemoglobin A1c was obtained for those with DM. Statistical analyses included one-way analyses of variance, Pearson correlations, and stepwise regression. RESULTS AND CONCLUSIONS Adolescents with type 1 DM had the lowest tHcy values (P <.05), which were reflective of the limited extant research with this population. Lipid profiles and dietary energy did not differ significantly among the 3 groups. Hemoglobin A1c was related to total cholesterol and triglycerides in those with type 1 DM, confirming the importance of promoting better metabolic control in lipid management for these youth. Future research should continue to explore the validity of tHcy and lipids as predictors of CV risks for youth with type 1 and type 2 DM.
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Abstract
BACKGROUND Incidence rates of both type 1 and type 2 diabetes mellitus (DM) are increasing in youth and may eventually contribute to premature heart disease in early adulthood. This investigation explored the influence of type of diabetes, gender, body mass index (BMI), metabolic control (HbA1c), exercise beliefs and physical activity on cardiovascular endurance (CE), and heart rate variability (HRV). Differences in exercise beliefs, physical activity, HRV, and CE in youth with type 1 versus type 2 DM were determined. METHODS Adolescents with type 1 DM (n = 105) or with type 2 DM (n = 27) completed the Exercise Belief Instrument and the Physical Activity Recall. Twenty-four HRV measures were obtained via Holter monitoring and analyzed using SpaceLabs Vision Premier software system. The McMaster cycle test was used to measure CE (V0(2peak)). RESULTS Regardless of the type of DM, females and those with higher BMI, poorer metabolic control, and lower amounts of physical activity tended to have lower levels of CE. Exercise beliefs consistently predicted both frequency and time domain HRV measures. Measures of exercise beliefs, self-reported physical activity, CE (V0(2peak)), and HRV were significantly lower in adolescents with type 2 DM in comparison to those with type 1 DM. CONCLUSIONS AND RECOMMENDATIONS Early findings of poor physical fitness, lower HRV, fewer positive beliefs about exercise, and less active lifestyles highlight the importance of developing culturally sensitive interventions for assisting youth to make lifelong changes in their physical activity routines. Females, those with poorer metabolic control, and minority youth with type 2 DM may be particularly vulnerable to later cardiovascular disease.
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MESH Headings
- Adolescent
- Attitude to Health
- Cardiovascular System/physiopathology
- Diabetes Mellitus, Type 1/metabolism
- Diabetes Mellitus, Type 1/physiopathology
- Diabetes Mellitus, Type 1/prevention & control
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 2/metabolism
- Diabetes Mellitus, Type 2/physiopathology
- Diabetes Mellitus, Type 2/prevention & control
- Diabetes Mellitus, Type 2/psychology
- Electrocardiography, Ambulatory
- Exercise Test
- Female
- Glycated Hemoglobin/metabolism
- Health Behavior
- Health Surveys
- Heart Rate
- Humans
- Male
- Midwestern United States
- Models, Psychological
- Physical Endurance
- Psychology, Adolescent
- Risk Factors
- Socioeconomic Factors
- Surveys and Questionnaires
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Affiliation(s)
- Melissa Spezia Faulkner
- Department of Maternal and Child Nursing, College of Nursing, University of Illinois at Chicago, 60612-7350, USA.
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Faulkner MS. Quality of life for adolescents with type 1 diabetes: parental and youth perspectives. Pediatr Nurs 2003; 29:362-8. [PMID: 14651307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
PURPOSE This descriptive correlational study explored quality of life for adolescents with type 1 diabetes versus healthy adolescents, and possible influences of age, gender, race, and metabolic control on quality of life and health perception of the adolescents with diabetes. SAMPLE Sixty-nine adolescents with type 1 diabetes treated at a pediatric diabetes center of a children's medical center in the Mid-South versus 75 healthy adolescents and their respective parents. METHODS Data were collected using the Diabetes Quality of Life Instrument for Youth, the Self-Perception Profile for Adolescents, the Children's Behavior Checklist (Competence Scales), and the Functional Status II. Chart data included the duration of diabetes, insulin dosage, most recent hemoglobin A1c, and average hemoglobin A1c over the past year. RESULTS Teens with diabetes expressed lower life satisfaction and health perception than controls; females with diabetes had lower life satisfaction than their male counterparts.
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Affiliation(s)
- Melissa Spezia Faulkner
- University of Illinois at Chicago, College of Nursing, Department of Maternal Child Nursing, Chicago, IL, USA
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Abstract
OBJECTIVE The purpose of this study was to determine effects of age, sex, race, body mass index, and Tanner's stage on short-term evoked cardiovascular autonomic tests (ie, Valsalva ratio and change in heart rate with deep breathing) and 24-hour heart rate variability (HRV) in a sample of healthy adolescents, as well as to identify normative indices of both short-term evoked and 24-hour HRV in this age group. DESIGN A descriptive, correlational design was used. SETTING Study took place in a university hospital in a health science center located in the mid-South. SUBJECTS Participants included 75 healthy adolescents: mean age was 15.0 +/- 1.6 years, 14 were African American, 61 were white, 49 were girls, and 26 were boys. OUTCOME MEASURES Study measures included the Valsalva ratio, change in heart rate with deep breathing, and 24-hour HRV with power spectral analysis with Holter monitoring. RESULTS Major significant findings included lower values of 24-hour HRV measures for girls and African American adolescents (P <.05). Indices for normal ranges of both the short-term evoked and 24-hour HRV measures were computed with 95% confidence intervals. CONCLUSIONS Few published studies address cardiac autonomic function, including 24-hour HRV, in adolescents. Most studies reporting actual normative control values of HRV for youth typically have not addressed sex or racial differences. Our study included the largest number of adolescents to date in the reported literature and demonstrated the importance of considering sex and race variation in interpreting test results. The availability of state-of-the-art technology for obtaining HRV data allows for the early identification of subclinical cardiac autonomic changes in youth who have predispositions for cardiac complications, such as those with diabetes, congenital heart disease, or obesity.
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Affiliation(s)
- Melissa Spezia Faulkner
- Department of Maternal-Child Nursing, College of Nursing, University of Illinois, Chicago, IL 60612, USA
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Faulkner MS. Low income mothers of overweight children had personal and environmental challenges in preventing and managing obesity. Evid Based Nurs 2002; 5:27. [PMID: 11915805 DOI: 10.1136/ebn.5.1.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Melissa Spezia Faulkner
- Department of Maternal-Child Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
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Abstract
BACKGROUND Limited data are available regarding the onset or trajectory of cardiovascular autonomic deterioration in persons with type 1 diabetes. OBJECTIVE To describe differences in heart rate variability among adolescents with type 1 diabetes, adults with type 1 diabetes who have coexisting renal failure, and adolescent and adult controls. RESEARCH DESIGN AND METHODS A correlational design was used to compare the status of heart rate variability in adults with type 1 diabetes and renal failure (n = 62); healthy adult controls (n = 67); adolescents with type 1 diabetes (n = 55); and healthy adolescent controls (n = 28). Convenience samples of adult patients with diabetes awaiting kidney or pancreas and kidney transplantation, and adolescents with diabetes were recruited from local university-based clinics. Volunteers served as healthy controls. The short-term R-R variability measures included in this study were changes in heart rate with deep breathing and with the Valsalva maneuver. Twenty-four hour ambulatory heart rate monitoring with power spectral analysis was also obtained to assess longterm R-R variability. RESULTS Adult patients with type 1 diabetes awaiting transplantation had significantly poorer heart rate variability measures than any of the other three populations studied (p < .0001). Adult control values also were significantly lower than either teenage controls or youths with diabetes (p < .05). Although most long-term R-R variability measures were lower in adolescents with diabetes versus controls, only one measure of parasympathetic modulation (i.e., pNN50) was significantly lower (p = .042). There were significant negative associations between HbA1c and sympathetic modulation (i.e., low hertz) in both the adult group (r= -.406, p = .029) and the adolescent group (r= -.324, p = .025) with diabetes. CONCLUSIONS Type 1 diabetes is associated with decreased heart rate variability, with the extent of the decrease related to the age of the individual and the severity of the disease.
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Affiliation(s)
- M S Faulkner
- College of Nursing, Department of Maternal and Child Nursing, University of Illinois at Chicago, 60612-7350, USA.
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Harris TT, Thomas CM, Wicks MN, Faulkner MS, Hathaway DK. Subjective burden in young and older African-American caregivers of patients with end stage renal disease awaiting transplant. Nephrol Nurs J 2000; 27:383-91, 355; discussion 392, 405. [PMID: 11276629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
The purposes of this study were to identify the level of subjective burden reported by African American caregivers of patients diagnosed with end stage renal disease (ESRD) awaiting transplantation and identify whether subjective burden, personal strain, and role strain varied by caregiver age. An exploratory descriptive survey design was used. The convenience sample consisted of 78 African American family caregivers. Subjects were obtained from a University transplant clinic in the Mid-South. Caregivers completed the 22-item self-administered Burden Interview (BI) and a demographic data form. Data were analyzed using descriptive statistics and the appropriate parametric and nonparametric tests of group differences. Most caregivers, reported little to none or mild to moderate burden. Results also indicated that there was no significant difference in the level of overall burden, personal strain, and role strain reported by young and older caregivers. Additional findings revealed that burden was least in the caregivers of patients who independently performed activities of daily living (ADL) and greatest among the caregivers of patients assisted by someone other than the caregiver with ADL. Findings from this study may help nurses to assist caregivers to identify their level of burden early in the caregiving process. Implementation of early interventions may prevent negative psychological and physical outcomes in these caregivers.
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Affiliation(s)
- T T Harris
- Graduate Health Sciences Program, University of Tennessee, Memphis, TN, USA
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Faulkner MS. Quality of life for persons with developmental disabilities. Sch Inq Nurs Pract 2000; 13:239-52; discussion 253-6. [PMID: 10628238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
A uniform and consensus definition for quality of life is not currently available. Although the topic of quality of life is pertinent for individuals with neurodevelopmental and related disabilities, the most appropriate means for assessing it as a basis for developing or evaluating programs need to be identified. A global viewpoint of one's quality of life when emotional, physical, or cognitive limitations are manifested may be too narrow for capturing a realistic perspective for planning programs. A more holistic approach that includes both individual and parental or caregiver perceptions may better address the conceptualization of quality of life for persons with developmental disabilities. Models of quality of life for this population reflect lifespan challenges for achieving personal satisfaction in the following areas: (1) physical well-being or functional status, (2) social and emotional well-being, (3) material well-being, and, (4) developmental abilities. This paper addresses current models of quality of life and methodological considerations for investigating this concept with persons who have developmental disabilities. Multidimensional methods of measurement, possibly including proxies, are necessary for a comprehensive approach to studying such an elusive construct, particularly when cognitive function is limited.
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Abstract
Long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency is a rare autosomal recessive disorder with varied expression, from severe hypoglycemia and possible sudden infant death to neurosensory deficits secondary to the acute onset. The neurosensory deficits can include clinical features such as seizure disorders, mental retardation, neuropathy, and retinopathy. The basic defect is the lack of the LCHAD enzyme in the liver, which is necessary for fatty acid metabolism. The condition is usually precipitated by infection and dehydration. A case example of a preschooler with LCHAD deficiency is presented to show the complexity of this disorder and resultant developmental disabilities. Implications for nursing practice, education, and research are discussed in relation to the needs of families with complex, developmental disabilities.
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Affiliation(s)
- M S Faulkner
- Boling Center for Developmental Disabilities, College of Nursing, University of Tennessee, Memphis 38163, USA
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Abstract
The purpose of this study was to examine the issue of quality of life (QOL) of parents with children and adolescents with type 1 diabetes. Parental QOL was measured by the Parents Diabetes Quality of Life Questionnaire. Parental life satisfaction was most affected by the burden the child's diabetes placed on the family. The event having the most impact on parental QOL was the frequency of telling others about the child's diabetes. The greatest worry was that the child would develop complications from diabetes. Parents of school-aged children experienced significantly greater life satisfaction than parents of adolescents. Married parents had higher life satisfaction than those who were divorced. Metabolic control, reflected by HbA1c values, was associated with the life satisfaction of parents.
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Affiliation(s)
- M S Faulkner
- The College of Nursing, University of Tennessee-Memphis, Memphis, Tennessee (Dr Faulkner)
| | - F S Clark
- The Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee (Ms Clark)
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Abstract
This study describes family responses to school-age children with diabetes and the influence of parents and siblings on self-care. Semistructured interviews of seven families living in a rural area of the Midwest were conducted. Major family responses included reminiscing about the time of diagnosis, changing the diet, scheduling daily routines, coping with and managing the diabetes, and worrying about insulin reactions. Mothers were the primary managers of the diabetes regimen. Blood-testing and self-injections were encouraged during less hurried times, particularly evenings and weekends.
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Affiliation(s)
- M S Faulkner
- College of Nursing, University of Tennessee, Memphis 38163, USA
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