Search

Background: Diabetes devices, like insulin pumps and continuous glucose monitors (CGMs), capture and store patient adherence and utilization data that can be retrieved or downloaded providing objective information on self-management behaviors; yet, diabetes device data remain underutilized in research. Objective: The aim of the study was to examine the usability and feasibility of personal diabetes device data collected using a clinical download platform retooled for research purposes. Methods: Investigators evaluated the feasibility of raw diabetes device data collection. One hundred eight preteens and adolescents with Type 1 diabetes and their parents provided consent/assent. Results: Data were successfully collected from the diabetes devices (insulin pumps and CGM) of 97 youth using a clinical download software adapted for research, including data from all three commercially available CGM systems and insulin pumps brands, which contained all current and previous models of each insulin pump brand. The time required to download, mode of connection, and process varied significantly between brands. Despite the use of an agnostic download software, some outdated device brands and cloud-based CGM data were unsupported during data collection. Within the download software, dummy clinical accounts were created for each study participant, which were then linked back to a master study account for data retrieval. Raw device data were extracted into seven to eight Excel files per participant, which were then used to develop aggregate daily measures. Discussion: Our analysis is the first of its kind to examine the feasibility of raw diabetes device data using a clinical download software. The investigators highlight issues encountered throughout the research process, along with mitigating strategies to inform future inquiry. Conclusion: This study demonstrates the feasibility of raw data collection, from a wide variety of insulin pump and CGM brands, through the retooling of a clinical download software. Data from these personal devices provide a unique opportunity to study self-management behavior and the glycemic response of individuals in their everyday environments. [ABSTRACT FROM AUTHOR]

Little is known about how sex as a biological variable may contribute to differences in quality of life (QOL) and mental health outcomes following a brief intervention among adolescent Syrian refugees. This paper explores the results of a secondary data analysis to investigate differences by sex on self-reported QOL and mental health outcomes among Syrian refugees who participated in a 7-session cognitive behavioral skills building intervention. A one group pretest–posttest design was used to deliver the intervention to 31 adolescent refugees (13–17 years; 15 male, and 16 female). At baseline, there were no significant differences between males and females on mean scores of depression, anxiety, or QOL. Post-intervention, self-reported scores for QOL and mental health were significantly different between sexes. Males demonstrated a significant decrease in anxiety scores compared to females. Among males only, significant decreases in depression and anxiety scores were observed with significant improvement in total QOL. [ABSTRACT FROM AUTHOR]

Purpose: Investigate the associations between psychosocial factors and physical activity. Design: Secondary data analysis utilizing baseline data of a large-scale community-based randomized controlled lifestyle behavior intervention. Setting: The Special Supplemental Program for Women, Infants, and Children in Michigan, USA. Subjects: Low-income overweight or obese mothers with young children (N = 740, 65% response rate). Measures: Survey data were collected via phone interview. Predictors included self-efficacy, autonomous motivation, emotional coping, and social support. Self-reported leisure physical activity was the outcome variable. Covariates were age, race, smoking, employment, education, body mass index, and postpartum status. Analysis: A multiple linear regression model was applied. Results: Self-efficacy (β =.32, 95% CI =.11,.52, P =.003) and autonomous motivation (β =.10, 95% CI =.03,.17, P =.005) were positively associated with physical activity. However, emotional coping and social support were not associated with physical activity. Conclusion: Future research should examine the longitudinal association of key psychosocial factors with physical activity. [ABSTRACT FROM AUTHOR]

Background. Minority teens with asthma are at particular risk for this life-threatening disease due to increased morbidity and mortality rates in addition to the normal challenges of adolescence. Objective. The purpose of this randomized controlled trial ( n = 137) was to determine the effects of a coping-skills training program (intervention) compared with standard asthma education (attention control) in African-American teens with asthma. Methods. Adolescents were recruited from five African-American dominant high schools serving low-income areas of Chicago. Data were collected at baseline, 2 months (immediately following the intervention), 6 months, and 12 months. Results. Both groups improved over time, with significant increases in asthma-related quality of life, asthma knowledge, and asthma self-efficacy, accompanied by decreases in symptom days and asthma-related school absences. Conclusions. Findings suggest that coping-skills training as implemented in this study provided no additional benefit beyond that experienced in the control group. However, group-based interventions delivered in the school setting may be beneficial for low-income, minority teens with asthma. [ABSTRACT FROM AUTHOR]

Topic: Early‐life experiences, the transmission of health and disease within families, and the influence of cumulative risks as well as protective factors throughout life shape the trajectory of health, including mental health. Long‐term health trajectories established early in life are influenced by biologic, social, and environmental factors. Negative trajectories may be more salient if exposures to adversity occur during critical developmental periods. Purpose: The purpose of this brief is to (a) review pediatric health disparities related to depression and the intergenerational transmission of pediatric depression using a Life Course Health Development (LCHD) model and (b) provide recommendations for pediatric mental health research. Sources: Peer‐reviewed papers available for PubMed, CINAL, and Medline. Other sources include published books, papers, and gray materials. Conclusions: The LCHD model is a perspective to guide and foster new scientific inquiry about the development of mental health outcomes over the life course. The model enables synthesis of mental health, nursing, and public health, linking mental health prevention, risk reduction, and treatment in children. [ABSTRACT FROM AUTHOR]

Lebanon has the highest per-capita concentration of refugees worldwide. There is an urgent need to offer psychosocial interventions to vulnerable groups such as Syrian refugee adolescents. To assess the feasibility, acceptability, and preliminary effects of a cognitive–behavioral intervention (Creating Opportunities for Patient Empowerment [COPE]) on depression, anxiety, and quality of life (QOL) in a sample of adolescent refugees (13-17 years) living in Lebanon. A preexperimental study design was used. COPE 7-Session was delivered to 31 adolescent Syrian refugees. Participants were assessed for depression (Personal Health Questionnaire–9), anxiety (General Anxiety Disorders Scale), and QOL (Pediatric Quality of Life Inventory). Feasibility and acceptability findings indicated that the COPE program was a positive experience for teens. Significant decreases in depression and anxiety, and increases in QOL were also reported. COPE is an effective cognitive–behavioral intervention that can be delivered in an Arabic/Middle-Eastern setting for teen refugees to improve mental health and QOL. [ABSTRACT FROM AUTHOR]

Background and purpose Little is known about the physical health, lifestyle beliefs and behaviors, and mental health among first-year health professional graduate students. Therefore, the purpose of this study was to describe these attributes as well as to explore the relationships among them. Methods A descriptive correlational study was conducted on the baseline data from a wellness onboarding intervention study with 93 health sciences students from seven different colleges within a large public land grant university in the Midwest United States. Findings Nearly 40% of the sample was overweight/obese, and 19% of students had elevated total cholesterol levels. Only 44% met the recommended 30 min of exercise 5 days per week. Forty-one percent reported elevated depressive symptoms and 28% had elevated anxiety. Four students reported suicidal ideation. Inverse relationships existed among depression/anxiety and healthy lifestyle beliefs/behaviors. Conclusions Students entering health professional schools are at high risk for depression, anxiety, and unhealthy behaviors, which could be averted through screening and early evidence-based interventions. Implications for practice Assessing the physical health, lifestyle behaviors, and mental health of first-year health sciences professional students is important to identify health problems and modifiable at-risk behaviors so that early interventions can be implemented to improve outcomes. [ABSTRACT FROM AUTHOR]

Objective: Only 17% of adolescents with type 1 diabetes (T1D) are currently meeting their glycemic targets despite advances in diabetes technologies. Self‐management behaviors and challenges specific to use of diabetes technologies are insufficiently studied in adolescents. We aimed to describe the experience of diabetes technology self‐management, including facilitators and barriers, among preteens/adolescents with low and high A1C. Research Design and Methods: Youth (10‐18 years of age) with T1D who use insulin pump therapy were recruited from the larger quantitative cohort of a mixed methods study for participation in semi‐structured qualitative interviews. Maximum variability sampling was used to recruit youth with A1C <7.5% (n = 5) and A1C >9% (n = 5). Participants' personal insulin pump and continuous glucose monitoring data were downloaded and served as a visual reference. Interviews were analyzed using a qualitative descriptive approach. Results: Participants were 50% female with a median age of 14.9 years and 80% used CGM. The sample was predominantly white (90.0%). Analysis produced four major themes, Bad Day, Expect the Unexpected, Nighttime Dependence, and Unpredictability, It's Really a Team and interconnecting subthemes. Youth characterized ''Bad Days'' as those requiring increased diabetes focus and self‐management effort. The unpredictability (''Expect the Unexpected'') of glucose outcomes despite attention to self‐management behaviors was considerable frustration. Conclusions: Diabetes devices such as insulin pumps are complex machines that rely heavily on individual proficiency, surveillance, and self‐management behaviors to achieve clinical benefit. Our findings highlight the dynamic nature of self‐management and the multitude of factors that feed youths' self‐management behaviors. [ABSTRACT FROM AUTHOR]

Purpose: Adolescent diabetes outcomes remain poor despite increased use of diabetes technologies such as insulin pump therapy. Meaningful research examining adolescent insulin pump self‐management has been done, however, a summary of these self‐management findings has not been published. The aim of this literature review is to map, evaluate, and summarize existing adolescent insulin pump self‐management research. Method: A scoping review of three databases was conducted to comprehensively report and synthesize relevant literature published before September 2019. Results: Of the 1295 titles identified, 18 articles met the inclusion criteria and were included in this scoping review. Key insulin pump self‐management behaviors were featured in the literature, most notably self‐monitoring of blood glucose (SMBG) and bolus frequency. Several factors were found to influence pump self‐management including psychological factors, parental support and self‐management transition, insulin pump education and knowledge acquisition, and environmental factors. We uncovered five gaps in the literature including: an unclear delineation of adolescent age; limited minority representation; variability in the definitions and reporting of self‐management behaviors; the role of data sharing and remote monitoring was not addressed; and there remains limited inquiry into diabetes burden and distress associated with insulin pump self‐management. Practice Implications: There exists a consensus that well‐established behaviors, such as bolus and SMBG frequency, influence glycemic outcomes for adolescent insulin pump users, however, full insulin pump utilization and self‐management is poorly understood. Diabetes clinicians should work to support adolescent insulin pump self‐management practices by reinforcing bedrock behaviors while fostering supportive factors found to influence pump self‐management. [ABSTRACT FROM AUTHOR]

Objective: Despite increased diabetes device use, few adolescents with type 1 diabetes (T1D) meet glycemic targets. We examine associations between utilization of insulin pumps and continuous glucose monitoring (CGM) and glycemic control. Research Design and Methods: This prospective cohort study included 80 youths (10‐18 years of age) with T1D. Multiple linear regression and linear mixed models (LMM) were used to estimate the effects of device self‐management on HbA1c and daily time in range (70‐180 mg/dL), respectively. Results: Every blood glucose (BG) input/day was associated with a 0.2% decrease in HbA1c (95% CI: −0.297, −0.013), each bolus/day was associated with a 0.2% decrease (−0.327, −0.057), and use of CGM was associated with a 0.5% decrease (−1.00, −0.075). Among CGM users (n = 45) every 10% increase in CGM use was associated with a 0.3% decrease in HbA1c (−0.390, −0.180). In LMM accounting for within subject and between subject variability, there was a negative association between BG input/day frequency (coefficient = −1.880, [−2.640, −1.117]) and time in range. Residual random effects for CGM users were large showing time in range varied between youth with a SD of 15.0% (3 hours and 36 minutes) (SE 2.029, [11.484, 19.530]). Time in range varied significantly from day‐to‐day with SD of 18.6% (4 hours and 40 minutes) (SE0.455, [17.690, 19.473]). Conclusions: Device self‐management behaviors among youth are significantly associated with both HbA1c and time in range. Our findings showing an association between reduced time in range and increased self‐management behaviors is novel and deserves further investigation. [ABSTRACT FROM AUTHOR]