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Lakatos PP, Rodas NV, Matic T, Williams ME, Samora LL, Carson MC. Providing Continuity in Infant Mental Health Services for Medically Fragile Infants and Their Families. J Clin Psychol Med Settings 2024; 31:5-18. [PMID: 37000305 PMCID: PMC10924710 DOI: 10.1007/s10880-023-09957-1] [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] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 04/01/2023]
Abstract
Having a baby who is prenatally or postnatally diagnosed with a medical condition places considerable stress on the parents, infants, and their developing relationship. Infant mental health (IMH) services offer an opportunity to address the challenges and support the parent-infant relationship. The present study outlined a continuum of care IMH program embedded within various medical settings of a large metropolitan children's hospital. Applications of IMH principles within the fetal care center, neonatal intensive care unit, high risk infant follow-up clinic, and the patient's home are described. Descriptive data about families served across settings and a case study are provided in order to illustrate the implementation of this unique IMH intervention model.
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Affiliation(s)
- Patricia P Lakatos
- Children's Hospital Los Angeles, University of Southern California University Center for Excellence in Developmental Disabilities, 4650 Sunset Blvd, MS#53, Los Angeles, CA, 90027, USA.
| | - Naomi V Rodas
- Children's Hospital Los Angeles, University of Southern California University Center for Excellence in Developmental Disabilities, 4650 Sunset Blvd, MS#53, Los Angeles, CA, 90027, USA
| | - Tamara Matic
- Children's Hospital Los Angeles, University of Southern California University Center for Excellence in Developmental Disabilities, 4650 Sunset Blvd, MS#53, Los Angeles, CA, 90027, USA
| | - Marian E Williams
- Children's Hospital Los Angeles, University of Southern California University Center for Excellence in Developmental Disabilities, 4650 Sunset Blvd, MS#53, Los Angeles, CA, 90027, USA
| | - Laura L Samora
- Children's Hospital Los Angeles, University of Southern California University Center for Excellence in Developmental Disabilities, 4650 Sunset Blvd, MS#53, Los Angeles, CA, 90027, USA
| | - Melissa C Carson
- Children's Hospital Los Angeles, University of Southern California University Center for Excellence in Developmental Disabilities, 4650 Sunset Blvd, MS#53, Los Angeles, CA, 90027, USA
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Vitale RJ, Laffel LMB. New-Onset Type 1 Diabetes in a Child With Diabetic Ketoacidosis and Severe Hypertriglyceridemia Without Pancreatitis. JCEM Case Rep 2023; 1:luad046. [PMID: 37223066 PMCID: PMC10201541 DOI: 10.1210/jcemcr/luad046] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Indexed: 05/25/2023]
Abstract
Hypertriglyceridemia is a complication of diabetic ketoacidosis (DKA) secondary to insulin deficiency inhibiting lipoprotein lipase and increasing lipolysis, but it is rare in children. A 7-year-old boy with history of autism spectrum disorder (ASD) presented with abdominal pain, vomiting, and "heavy breathing." Initial laboratory tests revealed pH 6.87 and glucose 385 mg/dL (21.4 mmol/L), consistent with new-onset diabetes and DKA. His blood appeared lipemic; triglycerides were 17 675 mg/dL (199.6 mmol/L) with normal lipase (10 units/L). He received intravenous insulin and DKA resolved within 24 hours. Insulin infusion continued through day 6 for management of hypertriglyceridemia; triglycerides decreased to 1290 mg/dL (14.6 mmol/L) during this period. He never developed pancreatitis (lipase peaked at 68 units/L) or required plasmapheresis. With his ASD history, he had a restrictive diet high in saturated fat, which included up to 30 breakfast sausages daily. His triglycerides normalized after discharge. Severe hypertriglyceridemia can complicate DKA in newly diagnosed type 1 diabetes (T1D). Hypertriglyceridemia can be safely managed with insulin infusion in the absence of end-organ dysfunction. This complication should be considered in patients with DKA at diagnosis of T1D.
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Affiliation(s)
- Rebecca J Vitale
- Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Boston, MA 02115, USA
- Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Boston, MA 02215, USA
- Division of Endocrinology, Department of Medicine, Brigham & Women's Hospital, Boston, MA 02115, USA
| | - Lori M B Laffel
- Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Boston, MA 02115, USA
- Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Boston, MA 02215, USA
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Dias HF, Mochizuki Y, Kühtreiber WM, Takahashi H, Zheng H, Faustman DL. Bacille Calmette Guerin (BCG) and prevention of types 1 and 2 diabetes: Results of two observational studies. PLoS One 2023; 18:e0276423. [PMID: 36662841 PMCID: PMC9858877 DOI: 10.1371/journal.pone.0276423] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/06/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Diabetes is a common disease marked by high blood sugars. An earlier clinical trial in type 1 diabetic subjects (T1Ds) found that repeat BCG vaccinations succeeded in lowering HbA1c values over a multi-year course. Here we seek to determine whether BCG therapy for bladder cancer may improve blood sugar levels in patients with comorbid T1D and type 2 diabetes (T2D). We also investigate whether BCG exposure may reduce onset of T1D and T2D by examining country-by-country impact of BCG childhood vaccination policies in relation to disease incidence. METHODS AND FINDINGS We first analyzed three large US patient datasets (Optum Labs data [N = 45 million], Massachusetts General Brigham [N = 6.5 million], and Quest Diagnostics [N = 263 million adults]), by sorting out subjects with documented T1D (N = 19) or T2D (N = 106) undergoing BCG therapy for bladder cancer, and then by retrospectively assessing BCG's subsequent year-by-year impact on blood sugar trends. Additionally, we performed an ecological analysis of global data to assess the country-by-country associations between mandatory neonatal BCG vaccination programs and T1D and T2D incidence. Multi-dose BCG therapy in adults with comorbid diabetes and bladder cancer was associated with multi-year and stable lowering of HbA1c in T1Ds, but not in T2Ds. The lack of a similar benefit in T2D may be due to concurrent administration of the diabetes drug metformin, which inhibits BCG's beneficial effect on glycolysis pathways. Countries with mandatory neonatal BCG vaccination policies had a lower incidence of T1D in two international databases and a lower incidence of T2D in one of the databases. CONCLUSIONS The epidemiological evidence analyzed here suggests that BCG may play a role in the prevention of T1D. It does not support prevention of T2D, most likely because of interference by metformin. Our ecological analysis of global data suggests a role for neonatal BCG in the prevention of T1D and, to a lesser extent, T2D. Randomized clinical trials are needed to confirm these findings.
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Affiliation(s)
- Hans F. Dias
- Immunobiology Department, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | | | - Willem M. Kühtreiber
- Immunobiology Department, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Hiroyuki Takahashi
- Immunobiology Department, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Hui Zheng
- Statistics Department, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Denise L. Faustman
- Immunobiology Department, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States of America
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4
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Ortiz La Banca R, Rebustini F, Alvarenga WA, de Carvalho EC, Lopes M, Milaszewski K, Nascimento LC. Checklists for Assessing Skills of Children With Type 1 Diabetes on Insulin Injection Technique. J Diabetes Sci Technol 2022; 16:742-750. [PMID: 33423543 PMCID: PMC9294572 DOI: 10.1177/1932296820984771] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND School-aged children often participate in type 1 diabetes (T1D) self-care tasks. Despite widespread discussion about the importance of developing self-care skills in childhood, few explain how the health care team should assess the skills of children with T1D when performing insulin injections. OBJECTIVE We sought to assess content validity evidence in two checklists regarding injection technique performed by children. METHODS Two checklists were designed based on a systematic review of the insulin injection technique. Experts in pediatric diabetes, health literacy, and diabetes education assessed the checklists regarding their clarity, objectivity, and relevance. Content validity was assessed using the content validity ratio (CVR). RESULTS Eleven providers (72% nurses or physicians, professional experience 19.4 ± 10.1 years, 45% of specialists in endocrinology, and 18% in pediatrics) participated in the assessment. Experts considered items containing the word homogeneity inappropriate. Items related to the needle insertion angle and the skin fold did not reach the CVR critical value. The final version of the checklist for syringe injection comprised 22 items with CVR = 0.91, and the checklist for pen injection comprised 18 items with CVR = 0.87. CONCLUSIONS The checklists presented clear, objective, and relevant content that assesses the skills of children with T1D for insulin injection. The checklists formally present the order of the technique and all the steps for insulin injection and allow a quantitative assessment of the operational skills of children. The developed instruments offer providers the possibility of continuous assessment of the progress of the pediatric clientele until they reach independence in diabetes self-care.
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Affiliation(s)
- Rebecca Ortiz La Banca
- Section on Clinical, Behavioral and
Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA,
USA
- Rebecca Ortiz La Banca, RN, MSN, PhD,
Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center,
Harvard Medical School, One Joslin Place, Boston, MA, 02215, USA.
| | - Flávio Rebustini
- Department of Gerontology, College of
Arts, Science and Humanities, University of Sao Paulo, São Paulo, SP, Brazil
| | | | - Emilia C. de Carvalho
- Ribeirao Preto College of Nursing,
University of Sao Paulo, Ribeirão Preto, SP, Brazil
| | - Mayara Lopes
- Paulista School of Nursing, Federal
University of Sao Paulo, São Paulo, SP, Brazil
| | - Kerry Milaszewski
- Section on Clinical, Behavioral and
Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA,
USA
| | - Lucila C. Nascimento
- Ribeirao Preto College of Nursing,
University of Sao Paulo, Ribeirão Preto, SP, Brazil
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Gonzalez Badillo FE, Zisi Tegou F, Abreu MM, Masina R, Sha D, Najjar M, Wright SH, Bayer AL, Korpos É, Pugliese A, Molano RD, Tomei AA. CCL21 Expression in β-Cells Induces Antigen-Expressing Stromal Cell Networks in the Pancreas and Prevents Autoimmune Diabetes in Mice. Diabetes 2019; 68:1990-2003. [PMID: 31371518 PMCID: PMC6754241 DOI: 10.2337/db19-0239] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 07/21/2019] [Indexed: 12/31/2022]
Abstract
Tumors induce tolerance toward their antigens by producing the chemokine CCL21, leading to the formation of tertiary lymphoid organs (TLOs). Ins2-CCL21 transgenic, nonobese diabetic (NOD) mice express CCL21 in pancreatic β-cells and do not develop autoimmune diabetes. We investigated by which mechanisms CCL21 expression prevented diabetes. Ins2-CCL21 mice develop TLOs by 4 weeks of age, consisting of naive CD4+ T cells compartmentalized within networks of CD45-gp38+CD31- fibroblastic reticular cell (FRC)-like cells. Importantly, 12-week-old Ins2-CCL21 TLOs contained FRC-like cells with higher contractility, regulatory, and anti-inflammatory properties and enhanced expression of β-cell autoantigens compared with nontransgenic NOD TLOs found in inflamed islets. Consistently, transgenic mice harbored fewer autoreactive T cells and a higher proportion of regulatory T cells in the islets. Using adoptive transfer and islet transplantation models, we demonstrate that TLO formation in Ins2-CCL21 transgenic islets is critical for the regulation of autoimmunity, and although the effect is systemic, the induction is mediated locally likely by lymphocyte trafficking through TLOs. Overall, our findings suggest that CCL21 promotes TLOs that differ from inflammatory TLOs found in type 1 diabetic islets in that they resemble lymph nodes, contain FRC-like cells expressing β-cell autoantigens, and are able to induce systemic and antigen-specific tolerance leading to diabetes prevention.
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Affiliation(s)
- Freddy E Gonzalez Badillo
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL
- Department of Biomedical Engineering, University of Miami, Miami, FL
| | - Flavia Zisi Tegou
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL
- Department of Biomedical Engineering, University of Miami, Miami, FL
| | - Maria M Abreu
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Riccardo Masina
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Divya Sha
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Mejdi Najjar
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Shane H Wright
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Allison L Bayer
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, FL
| | - Éva Korpos
- Institute of Physiological Chemistry and Pathobiochemistry and Cells in Motion, Cluster of Excellence, University of Muenster, Muenster, Germany
| | - Alberto Pugliese
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL
- Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, FL
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - R Damaris Molano
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL
| | - Alice A Tomei
- Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL
- Department of Biomedical Engineering, University of Miami, Miami, FL
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
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