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Background The opioid epidemic continues and although some initiatives have shown promise in reducing the number of opiates prescribed, few studies have focused on education of general surgery patients about home storage and safe disposal. The purpose of this feasibility study was to explore the use of an online video intervention to prepare surgical patients to properly dispose of unused opioids. Methods Eligible patients undergoing elective general surgery between August and October 2019 were enrolled into this prospective randomized controlled feasibility study. Patients with reported opioid use preoperatively were excluded from the study. The control group followed usual care, and the intervention group received usual care plus a brief educational video guided by the theory of reasoned action describing safe storage and disposal practices of unused opioid pills. Measures were collected at baseline and 2 wk postoperatively. Results A total of 40 participants were enrolled in the study; average age was 44.7 (range 21-75 y); most were Caucasian, educated, and employed. Recruitment took 11 wk, and the retention rate was excellent at 85%. Differences in opioid disposal were not significantly different by age, sex, education, or type of surgery. The video intervention was positively received, but the majority (80%) still stored their pills unsecured. Conclusions Results demonstrate that a video intervention addressing safe storage and disposal practices of unused opioids is feasible, and more research is needed to determine efficacy in increasing rates of secure storage and disposal of unused opioid pills.

PurposeThe purpose of this qualitative descriptive study undergirded by Meleis’s Transition Framework was to explore developmental, situational, and organizational challenges experienced by a diverse group of emerging adults (18-29 years old) with type 1 diabetes (T1DM). Their perspectives on creating a developmentally informed diabetes self-management (DSM) program that supports transitional care were also explored.MethodsA purposive sample of emerging adults with T1DM was recruited from the pediatric and adult diabetes clinics of an urban academic medical center. Those who consented participated in either a single focus group or a single interview. Self-reported demographic and clinical information was also collected.ResultsThe sample was comprised of 21 emerging adults, with an average age of 23.6 ± 2.6 years, diabetes duration of 14.7 ± 5.0 years, and 71% female. Four main themes emerged: (1) finding a balance between diabetes and life, (2) the desire to be in control of their diabetes, (3) the hidden burden of diabetes, and (4) the desire to have a connection with their diabetes provider. Use of insulin pumps and continuous glucose monitors and attendance at diabetes camp decreased some of the DSM challenges. Different groups of individuals had different perspectives on living with diabetes and different approaches to DSM.ConclusionsThe emerging adults in this study had a strong desire to be in good glycemic control. However, all participants described having a hard time balancing DSM with other competing life priorities. They also desired personalized patient-provider interactions with their diabetes care provider in clinical follow-up services. Even though the study sample was small, important themes emerged that warrant further exploration.

Background The hospitalization of a family member in an intensive care unit can be stressful for the family. Family bedside rounds is a way for the care team to inform family members, answer questions, and involve them in care decisions. The experiences of family members with intensive care unit bedside rounds have been examined in few studies. Objectives To describe (1) the experiences of family members of patients in the intensive care unit who participated in family bedside rounds (ie, view of the illness, role in future management, and long-term consequences on individual and family functioning) and (2) the experiences of families who chose not to participate in family bedside rounds and their perspectives regarding its value, their illness view, and future involvement in care. Methods A qualitative descriptive study was done, undergirded by the Family Management Style Framework, examining families that participated and those that did not. Results Most families that participated (80%) found the process helpful. One overarching theme, Making a Connection: Comfort and Confidence, emerged from participating families. Two major factors influenced how that connection was made: consistency and preparing families for the future. Three types of consistency were identified: consistency in information being shared, in when rounds were being held, and in informing families of rounding delays. In terms of preparing families for the future, families appeared to feel comfortable with the situation when a connection was present. When any of the factors were missing, families described feelings of anger, frustration, and fear. Family members who did not participate described similar feelings and fear of the unknown because of not having participated. Conclusion What health care providers say to patients’ families matters. Families may need to be included in decision-making with honest, consistent, easy-to-understand information.

Purpose The purpose of this study was to develop and evaluate the psychometric properties of the Peer-Mentor Support Scale (PMSS), a measure of peer-mentor support provided to parents of children with type 1 diabetes (T1D) and to youths with T1D. Methods A multistage process was undertaken to include the following: item construction based on qualitive data from those who have experienced peer-mentor support, cognitive interviewing with parents and youths, content validity assessment, pilot testing of the scale, and psychometric evaluation of the PMSS with 165 participants. Results The final version of the PMSS included 17 items, scored on a 4-point Likert scale, with higher scores corresponding with greater peer-mentor support. The Cronbach’s alpha was .85 (n = 165), and the intraclass correlation coefficient was .78 (n = 38). No significant relationship was found between the PMSS score and general social support, suggesting that peer-mentor support is distinct from general social support. Principal components factor analysis with varimax rotation was performed, indicating that the scale was unidimensional and explained 59.3% of the variance in peer-mentor support. Conclusion The PMSS is a reliable and valid 17-item instrument that can be used to measure the unique contributions of peer mentorship for parents of children with T1DM and for youths with T1DM.

The aims of this qualitative descriptive study were to describe how past experiences with research (including communication, information, values, and support) may contribute to research fatigue among youth and parents of youth with HIV, cystic fibrosis, and Type 1 diabetes. Eighteen parents and youth were purposively recruited from outpatient subspecialty clinics at a major academic medical center. They took part in qualitative interviews and completed a demographics form and the Decisional Conflict Scale. Youth participants also completed the Erikson Psychosocial Stage Inventory. Two major themes emerged: Blurred Lines and Hope for the Future. Research fatigue was not found in this sample. Results point to challenges with informed consent in settings where research and clinical care are integrated and suggest that protective factors allow for continued participation without excess burden on youth and parents. Strategies to minimize research fatigue and support engagement in research are offered.

BACKGROUND: Parents often become the caregivers for their adult children with serious mental illness (SMI) due to the chronic and debilitating course of the illness and shortages in funding for community mental health services and residential placements. OBJECTIVE: To examine parents’ management styles when caring for adult children with SMI and parents’ perspectives on what type of community-based mental health interventions would support and/or enhance overall family functioning. DESIGN: A qualitative descriptive study using semistructured interviews with parents caring for adult children with SMI. The study was undergirded by Knafl and Deatrick’s Family Management Style Framework. RESULTS: Four major themes emerged from the data describing prolonged and difficult phases that parents and the family undergo in caring for an adult child with SMI. CONCLUSIONS: Successful management of these phases must include increasing access to mental health information, mental health screening, early interventions, and violence prevention for adult children and their families.

Background: Measurement of intervention fidelity is an essential component of any scientifically sound intervention trial. However, few papers have proposed ways to integrate intervention fidelity data into the execution of these trials. Objective: The purpose of this article is to describe the intervention fidelity process used in a randomized controlled trial of a human patient simulator intervention and how these data were used to monitor drift and provide feedback to improve the consistency of both intervention and control delivery over time in a multisite education intervention for parents of children with newly diagnosed Type 1 diabetes. Methods: Intervention fidelity was measured for both the intervention and control condition by direct observation, self-report of interventionist delivery, and parent participant receipt of educational information. Intervention fidelity data were analyzed after 50%, 75%, and 100% of the participants had been recruited and compared by group (treatment and control) and research site. Results: The sample included 191 parents of young children newly diagnosed with Type 1 diabetes. Observations scores in both intervention and control groups indicated a high level of intervention fidelity. Treatment receipt was also high and did not differ by treatment group. The teaching session attendance rates by site and session were significantly different at Time Point 1 (50% enrollment); following study staff retraining and reinforcement, there were no significant differences at Time Point 3 (100% enrollment). Implications: Results demonstrate the importance of monitoring intervention fidelity in both the intervention and control condition over time and using these data to correct drift during the course of a multisite clinical trial.

Objective Parents who have a child newly diagnosed with type 1 diabetes (T1D) must quickly learn daily diabetes self-management. An RCT was conducted using human patient simulation (HPS) to enhance parents learning diabetes self-management with children with new-onset T1D. The purpose of this study was to describe parents’ perspectives of using HPS to augment diabetes education. Methods A qualitative descriptive design was used with open-ended in-depth interviews of parents (n = 49) post-intervention. Qualitative directed content analysis was used. Results The majority of parents were positive about learning with HPS. Although a few parents said the HPS was “hokey” or “creepy,” most reported the visual and hands-on learning was realistic and very beneficial. Seeing a seizure increased their fear although they would have panicked if they had not had that learning experience, and it helped build their diabetes self-management confidence. Recommendations included teaching others with the HPS (grandparents, siblings, babysitters, and school nurses). Conclusion HPS-enhanced education is an acceptable and viable option that was generally well-received by parents of children with new-onset T1D. Practice implications The technique should be studied with parents of children with other chronic illnesses to see if the benefits found in this study are applicable to other settings.

BACKGROUND AND OBJECTIVES: There is increasing emphasis on the importance of patient and family engagement for improving patient safety. Our purpose in this study was to understand health care team perspectives on parent-provider safety partnerships for hospitalized US children to complement a parallel study of parent perspectives. METHODS: Our research team, including a family advisor, conducted semistructured interviews and focus groups of a purposive sample of 20 inpatient pediatric providers (nurses, patient care technicians, physicians) in an acute-care pediatric unit at a US urban tertiary hospital. We used a constant comparison technique and qualitative thematic content analysis. RESULTS: Themes emerged from providers on facilitators, barriers, and role negotiation and/or balancing interpersonal interactions in parent-provider safety partnership. Facilitators included the following: (1) mutual respect of roles, (2) parent advocacy and rule-following, and (3) provider quality care, empathetic adaptability, and transparent communication of expectations. Barriers included the following: (1) lack of respect, (2) differences in parent versus provider risk perception and parent lack of availability, and (3) provider medical errors and inconsistent communication, lack of engagement skills and time, and fear of overwhelming information. Providers described themes related to balancing parent advocacy with clinician’s expertise, a provider’s personal response to challenges to the professional role, and parents balancing relationship building with escalating safety concerns. CONCLUSIONS: To keep children safe in the hospital, providers balance perceived challenges to their personal and professional roles continuously in interpersonal interactions, paralleling parent concerns about role ambiguity and trust. Understanding these shared barriers to and facilitators of parent-provider safety partnerships can inform system design, parent education, and professional training.

Purpose The purpose of this article is to report the focus group perspectives of preteens’ and parents’ experiences with a feasibility intervention entitled PREP-T1 (Preteen Re-Education with Parents–Type 1 Diabetes), an interactive education and peer mentoring intervention. Methods The parent and preteen focus groups were conducted by the principal investigator, coinvestigator, and note takers at 2 sites. The preteen-parent groups were conducted concurrently with a total of 11 preteens and 11 parents. Note-based qualitative content analysis was used, resulting in preteen-parent perspectives on reeducation and strategies for families to work more effectively in managing type 1 diabetes (T1DM). Results The findings suggest that the preteens enjoyed learning about their diabetes management from a teen educator mentor in conjunction with a human patient simulator. They reported this type of peer support would benefit other preteens with T1DM. Parents were overwhelmingly positive about their interactions with the parent educator mentor in conjunction with the psychologist and about focusing on how to better collaborate with their preteens on diabetes management decision making. Further recommendations about the timing and intervention dose were also discussed. Conclusions Moderated peer mentoring with technology has potential as a means for teaching preteens and their parents shared diabetes management. These data will be used to inform the PREP-T1 fully powered intervention study.

Background and Purpose: The purpose of this study was to develop a reliable and valid measure of faculty response patterns to the needs of underrepresented minority (URM) nursing students. Methods: A mixed-method approach. Results: The 10-item scale was found to be valid (content validity index [CVI] = .81) and reliable (Cronbach's alpha = .81). Principle component factor analysis with varimax rotation yielded a 3-factor solution that explained 66% of the variance in faculty engagement with URM students. The Cronbach's alpha for the 3 factors ranged from .72 to .78. Higher scores were associated with older faculty who had been teaching longer and had more experience teaching URM students. Conclusion and Implications: The results of the study provide preliminary evidence for the internal consistency and content, criterion-related, and construct validity of the scale.

Purpose The purpose of this exploratory focus group study was to describe the perspectives of teens and their parents about self-management knowledge, behaviors (including division of labor associated with T1D management), and resources used to manage T1D. The overall goal is to use this information to develop a teen–family transition clinic. Methods The self and family management behaviors framework undergirded the separate teen–parent focus groups that were conducted concurrently. Note-based qualitative content analysis was used, resulting in several important messages. Results From the teens’ perspective there was variation in interest in learning more about T1D and management. Those teens who had been diagnosed at a very young age reported not knowing anything else but diabetes, while those diagnosed later developmentally embraced the active learning process. Diabetes camp and peer group support were not seen as beneficial. All the teens were interested in “helping others” with diabetes. Parents shared the common struggle with transition of self-management, with variation in parenting styles. A small group of parents reported their “job” as a parent was to make sure their child was self-sufficient in self-management, but felt pressure from the health care providers (HCPs) to physically do the care, defeating the purpose. Parents and teens reported wanting HCPs to be less focused on “numbers” (blood glucose levels) and more on the whole person. Scheduling appointment changes and long waiting times were reported as problematic by all participants. Conclusions Teen and parent perspectives are critical in designing future well-received adolescent–family transition clinics. Development from the ground up with family recommendations may contribute to high-quality health outcomes.

Purpose The purpose of this article is to describe the 4 Parent Education Through Simulation-Diabetes (PETS-D) nurse certified diabetes educators’ (CDEs) perspectives of teaching parents of children with newly diagnosed type 1 diabetes mellitus (T1DM) early diabetes management skills using formal vignettes and a human patient simulator/human patient simulation (HPS) to augment/enhance the teaching–learning process. Methods A qualitative descriptive approach was used. Four CDEs were interviewed by phone about their teaching experiences. Meticulous notes were taken. Data were analyzed using qualitative content analysis. Results The vignettes (and use of HPS) provided structure, especially for parents who were struggling to learn. Certified diabetes educators described a short learning curve to master the use of the HPS manikin. Human patient simulation-enhanced education was described as helpful for teaching multiple caregivers about diabetes. Certified diabetes educators also described factors that affect parent learning, mechanical issues with the HPS, and additional space requirements for HPS-enhanced education. Conclusion Vignettes and HPS-enhanced education can successfully be used to educate parents of children with new-onset T1DM and were preferred by the CDEs when compared with previous teaching strategies. The results of this study support the use of both vignette-based and HPS-enhanced education when a child is newly diagnosed with T1DM. Further studies need to be done to see if these effects persist with different populations, during different stages of the disease, and for individuals with other chronic illnesses.

There has been a 2% to 3% increase in Type 1 diabetes (T1D) in children below 11 years old. Preteens (9-12 years old) with T1D are often overlooked regarding future diabetes self-management (DSM) expectations because parents are still in the “driver’s seat.” The study purpose was to explore feasibility/ability to recruit and conduct a two-arm trial on reeducation, collaboration, and social support. One component of DSM was reviewed (hypoglycemia) with preteens ( n = 22) and parents ( n = 22). The experimental preteens discussed hypoglycemia management with a teen mentor and nurse educator using a human patient simulator for practice, and working collaboratively with parents. Concurrently, mothers met with a parent mentor and psychologist to discuss growth and development, and collaborative shared management. Comparison dyads discussed hypoglycemia management with a nurse. Preteens slightly improved in diabetes knowledge; the experimental arm had higher problem-solving scores. Parents in the experimental arm had higher self-efficacy scores. Findings will inform future research.

This study explored parents' perspectives regarding their involvement in safety for their hospitalized children. We employed qualitative description and semistructured interviews of parents of children in an urban tertiary hospital ward. Content analysis revealed 4 parent themes: risks to child safety and comfort, hospital role as a protector, participation in safety varies by individual and organizational factors, and balancing safety with "speaking up" interpersonal risks. We suggest key concepts to incorporate into staff education and family engagement/safety programs to develop effective partnerships between clinicians and parents.

Objectives. We used a community-based participatory research (CBPR) approach to plan and implement free TB skin testing at an adult education center to determine the efficacy of CBPR with voluntary tuberculosis (TB) screening and the prevalence of TB infection among immigrant and refugee populations. Methods. We formed a CBPR partnership to address TB screening at an adult education center that serves a large immigrant and refugee population in Rochester, Minnesota. We conducted focus groups involving educators, health providers, and students of the education center, and used this input to implement TB education and TB skin testing among the center's students. Results. A total of 259 adult learners volunteered to be skin-tested in April 2009; 48 (18.5%) had positive TB skin tests. Conclusions. Our results imply that TB skin testing at adult education centers that serve large foreign-born populations may be effective. Our findings also show that a participatory process may enhance the willingness of foreign-born persons to participate in TB skin-testing efforts.

Purpose The purpose of this mixed-methods descriptive study with parents of children newly diagnosed with type 1 diabetes was to explore their experiences with peer social support following the Social Support to Empower Parents (STEP) intervention and the usefulness of the Family Management Measure (FaMM) in this population. Methods Parents who were in the experimental arm of STEP were recruited. Qualitative interviews were conducted (n = 21), and 11 parents completed the FaMM, a quantitative family-functioning measure. Qualitative content data analysis was conducted and compared to the descriptive measure analysis. Findings Three themes were identified: availability, practical tips, and common ground. Five FaMM subscales were reliable (α > .80) in this small sample. Conclusions The findings illustrate that the STEP intervention is helpful, providing the participants with emotional, affirmational, and informational social support. The use of the FaMM is a first step in assessing family management in families with children with type 1 diabetes.

Purpose The purpose of this study was to examine differences in self-management behaviors (Collaboration with Parents, Diabetes Care Activities, Diabetes Problem Solving, Diabetes Communication, and Goals) between early, middle, and late adolescence. The role of regimen and gender as covariates in self-management behaviors was also examined. Methods This was a secondary analysis with a cross-sectional descriptive survey design. A sample of 504 participants ages 13 to 21 years from the Self-Management of Diabetes–Adolescent instrument development study were analyzed to determine self-management behaviors in early, middle, and late adolescence. This study was partially guided by the Self and Family Management Framework. This framework contains broad conceptual areas that are thought to pose a risk to or have a protective influence on self-management and family management behaviors and associated outcomes. Results Significant findings included a decline between early, middle, and late adolescence in the Collaboration with Parents scale as well as an increase between early and late adolescence on the Diabetes Problem Solving scale. Regimen was a significant covariate for Collaboration with Parents, Diabetes Care Activities, and Diabetes Problem Solving, and gender was a significant covariate for Diabetes Care Activities and Diabetes Communication. Conclusions Clinicians should consider the influence of adolescent stage and development on self-management when educating adolescents. Youth and their families should be educated to consider the implications that regimen will have on daily self-management when making treatment decisions. Furthermore, gender variations can necessitate different educational approaches to meet different needs. Future research should identify other variables that can influence self-management at different points across adolescence.

This study was undertaken to improve the cultural and linguistic sensitivity of an established parent-mentor training curriculum for Latino parents of young children newly diagnosed with type 1 diabetes. The cultural sensitivity of curriculum components was determined by interviewing four Latino mothers raising five children (aged 7 to 12 years) with type 1 diabetes. The mothers recommended offering resources in English and Spanish, including access to bilingual taxi service, providing access to family diabetes education on child development and preparation of healthy traditional cultural foods, and training for babysitting children with diabetes. They also suggested offering after-school and weekend diabetes clinics to decrease interference with work and school activities.

One hundred twelve pregnant women who were diagnosed depressed were randomly assigned to a group who received group Interpersonal Psychotherapy or to a group who received both group Interpersonal Psychotherapy and massage therapy. The group Interpersonal Psychotherapy (one hour sessions) and massage therapy (30 minute sessions) were held once per week for six weeks. The data suggested that the group who received psychotherapy plus massage attended more sessions on average, and a greater percentage of that group completed the six-week program. The group who received both therapies also showed a greater decrease in depression, depressed affect and somatic-vegetative symptom scores on the Center for Epidemiological Studies Depression Scale (CES-D), a greater decrease in anxiety scale (STAI) scores and a greater decrease in cortisol levels. The group therapy process appeared to be effective for both groups as suggested by the increased expression of both positive and negative affect and relatedness during the group therapy sessions. Thus, the data highlight the effectiveness of group Interpersonal Psychotherapy and particularly when combined with massage therapy for reducing prenatal depression.

Purpose The purpose of this study was to explore the feasibility of using human patient simulation (HPS) to teach type 1 diabetes (T1DM) management to grandparents of grandchildren with T1DM. Methods Thirty grandparents (11 male, 19 female) of young grandchildren (aged 12 and under) with T1DM were recruited from an urban medical center. Experimental group (n = 14) grandparents received hands-on visual T1DM management education using an HPS intervention, and control group (n = 16) grandparents received similar education using a non-HPS intervention. Findings This study demonstrated the feasibility of recruiting and retaining grandparents into a clinical trial using HPS to teach T1DM management. Post intervention, all grandparent scores for T1DM knowledge, confidence, and fear showed significant improvement from time 1 to time 2, with HPS group grandparent scores showing consistently larger improvement. Conclusions The consistency of larger HPS-taught grandparent score improvement is suggestive of a benefit for the HPS teaching method. Early multimethod Certified Diabetes Educator (CDE)–provided T1DM education is an important point of entry for inducting grandparent members onto the grandchild’s diabetes care team.

Objective To evaluate the efficacy of Parent Education Through Simulation–Diabetes (PETS-D; clinical trial registration NCT01517269) for parents of children Design and Methods Subjects were randomized to the HPS parent diabetes education or the vignette-only arm. Using linear mixed modeling, we compared HPS and vignette-only groups at 2, 6, and 14 weeks. Effect modification of treatment by dichotomized child’s age (high school) was also tested. All analyses were intent to treat and adjusted for baseline outcome level and clustering within site. Results We recruited 191 parents (116 children). Mean baseline A1C was 12%. Overall treatment-related differences were modest. There was a statistically significant effect modification of HPS by child’s age, with a larger HPS benefit among parents of younger children for several outcomes: A1C (8.16% vs 9.48% in control; P = .006), lower state anxiety ( P = .0094), and higher fear of hypoglycemia ( P = .03) for parents of children Conclusions Modest treatment-related differences may reflect ceiling/floor effects in many of the outcomes; we also compared HPS with another intervention rather than to usual education. Parents of younger children receiving the intervention may feel more comfortable with lower A1C levels because of management awareness gleaned from the HPS experience. Future research will include a retrospective case-control study of very young children.

Purpose To describe fathers' experiences in parenting and managing the care of their young children with type 1 diabetes. Design and methods This qualitative descriptive study used 16 open-ended, in-depth interviews with 14 purposively selected, involved, educated, stably employed fathers of 15 children younger than 10 years old. The fathers were asked to describe their perspective of the initial diagnosis, how they learned diabetes care, their day-to-day care and parenting experiences, and what strategies they used in the day-to-day management. Data were managed using NVivo software and analyzed using principles of naturalistic inquiry and qualitative content analysis. Results The overarching theme was "From sadness to action," with six categories emerging: (1) "shock and awe" (after diagnosis), (2) quick response to the diagnosis and learning diabetes care: "suck it up and do it," (3) "staying in the loop" (practicing the skills, tasks, and responsibilities of diabetes management), (4) "partnerships in care" (tag teaming or co-parenting), (5) active participation (being actively involved in their children's day-to-day care and benefiting from participating in this care), and (6) mantra for living with diabetes: child first, diabetes second. Clinical implications Nurses working with children with diabetes can use the results of this study to better understand the role of fathers in the care of these children. Fathers underscored the importance of practicing diabetes care-related tasks to improve their confidence when caring for children alone. Their practical and philosophical strategies for managing their children's chronic illness have recently been incorporated into a parent mentor intervention for children newly diagnosed with type 1 diabetes.

In two studies, healthy elderly adults were poor at recognizing certain emotions. In study one, an emotion face morphed to express a new emotion. The elderly were impaired when recognizing anger and sadness, whereas no differences were found between the two age groups in recognizing fear or happiness, or in a task requiring reasoning about non=emotion stimuli. In study two, the elderly were impaired when judging which of two faces was more angry, sad, or fearful, but they were not impaired when judging other emotions or when judging which of two beakers was more full. The elderly were also impaired when matching emotion sounds to angry, sad, and disgusted faces, but not to other emotions and not when matching non-emotion (e.g., machine) sounds to machines. Elderly deficits were independent of performance on a task requiring basic face processing (gender recognition). Overall, the results provide support for an age-related decline in the recognition of some emotions that is independent of changes in perceptual abilities, processing speed, fluid IQ, basic face processing abilities, and reasoning about non face stimuli. Recognition of emotion stimuli might be mediated by regions of the brain that are independent from those associated with a more general cognitive decline.

Purpose To describe the process that mothers raising young (0-4 years old) children who are newly diagnosed with type 1 diabetes move through to attain the necessary skills to care for their children. Study design and methods A mixed methods design was used, including qualitative interviews with 28 mothers of young children with type 1 diabetes. Principles of naturalistic inquiry were used to guide the data collection process, management, and analysis of the qualitative findings. Results The process paralleled two of three management approaches and associated behaviors previously described by Gallo and Knafl. Strict adherence behaviors included rigidly following the team recommendations and avoiding strange environments outside the home. Flexible adherence behaviors strove to bring spontaneity back into family life. Selective adherence was not used by this population. Clinical implications Nurses working with these mothers can provide information and support to help them transition from using strict adherence to the more user-friendly flexible adherence, while avoiding the pitfalls of the possibly harmful third approach of selective adherence. Nurses need to remember to praise the parents' efforts at managing their children's diabetes, for our acknowledgment of their work is empowering and affirming.

Little is known about the experiences of mothers raising young children with type 1 diabetes. The purpose of this study was to describe the day-to-day experiences of mothers (N = 28) raising young children under 4 years of age with type 1 diabetes. Descriptive, naturalistic inquiry principles were used to interview subjects, as well as to manage and analyze the data. The mothers reported using the management behavior of constant vigilance. Their concerns about hypoglycemia and providing competent care reflected the interplay between their fears and profound sense of responsibility for managing the disease. Mothers reported having to learn the management behaviors and to occasionally adjust the day-to-day management when either severe hypoglycemia or developmental milestones occurred. Although mothers initially had feelings of incompetence with the care they provided, with time, they became very skilled. There were also reports of limited access to babysitting, child care, or respite services. The intensity of their constant vigilance associated with their concerns, responsibility, and lack of supports resulted in some mothers having physical and/or emotional problems. The findings of the study highlight the importance of identifying family and/or community resources that may provide mothers with support that could reduce some of the tremendous stress and burden of responsibility experienced after diagnosis of diabetes.

issues and purpose.To examine the day-to-day experiences of mothers raising children 4 years of age and younger with type 1 diabetes. design and methods.The descriptive design compared mothers of children with (n = 25) and without diabetes (n = 25). Mother-child observations were completed for children with diabetes. results.Mothers of children with diabetes are very skilled in reading their children's behavioral cues. Mothers'concerns included the fear of hypoglycemia and seizure activity, access to daycare centers, and babysitting services capable of caring for their children's condition. These responses significantly differed from the control group mothers. practice implications.Nurses can affirm that hypoglycemia-related fears are normal and help mothers identify community resources that might ease the burden of care required, especially during the early postdiagnosis period.

GB virus C (GBV-C), also known as human pegivirus, is an RNA virus within the Pegivirus genus in the Flaviviridae family [1, 2] and is found within T and B lymphocytes, natural killer (NK) cells, and monocytes [3, 4]. GBV-C can cause persistent human infection, especially in immunosuppressed individuals [5]; however, 60%–75% of immune competent individuals resolve viremia, coincident with the development of anti–GBV-C E2 antibodies [6]. GBV-C is transmitted sexually, vertically, and parentally through infected blood products [7–11]. GBV-C is common in healthy blood donors in developed countries, with 1%–4% testing positive for GBV-C RNA and 17% having viral envelope protein E2 (E2) antibodies [12–14]. Studies have failed to demonstrate an association with any particular disease [15–17], with the potential exception of an association with non-Hodgkin lymphoma [18–20]. Further research is needed to determine whether this association is causally related to GBV-C infection. Therefore, blood products are not routinely screened for the presence of GBV-C RNA [6, 21]. GBV-C RNA prevalence was 7% in the Viral Activation Transfusion Study (VATS) cohort and individuals with advanced human immunodeficiency virus (HIV) infection [22]. E2 antibody–negative, transfusion-naive VATS subjects developed GBV-C viremia within 120 days after transfusion, with a 9% incident infection rate per unit transfused [22]. Reports have shown an association between GBV-C and prolonged survival in HIV-infected individuals with active GBV-C coinfection [12]. GBV-C viremia is associated with slower HIV disease progression, and coinfected subjects have lower HIV viral loads and higher CD4+ T-cell than HIV-1–monoinfected patients [8, 23, 24]. We recently reported that HIV-infected people acquiring incident GBV-C infection following transfusion have longer survival durations than HIV-infected people who underwent transfusion but did not acquire GBV-C infection [25]. The findings suggested that the intentional infection of HIV-positive individuals with GBV-C could represent a therapeutic approach for HIV infection [26]. The host immunological response underlying GBV-C and HIV coinfection that may contribute to reduced HIV replication and CD4+ T-cell loss and, consequently, to better survival are not well characterized. Prior studies found reduced lymphocyte, monocyte, and NK cell markers of activation in patients with HIV and GBV-C coinfection, compared with those with HIV monoinfection, suggesting that GBV-C infection may modulate host inflammation, thus reducing HIV replication and pathogenesis [27–31]. Furthermore, in vitro studies suggest that E2 and virus particles interfere with T-cell activation and proliferation [32–35]. Here, VATS plasma samples were evaluated for cytokine and chemokine levels during acute GBV-C viremia following transfusion-associated transmission in HIV-infected patients. With HIV disease progression markers, treatment data, and GBV-C infection parameters, this longitudinal study provided a unique opportunity to characterize the patterns of cytokines and chemokines during incident GBV-C coinfection and provides insight into the immune mechanisms underlying the protective role of GBV-C coinfection in HIV-infected patients.

OBJECTIVES: Research indicates that older adults’ (≥ 60 years) emotion recognition is worse than that of young adults, young and older men’s emotion recognition is worse than that of young and older women (respectively), older adults’ looking at mouths compared to eyes is greater than that of young adults. Nevertheless, previous research has not compared older men’s and women’s looking at emotion faces so the present study had two aims: (1) to examine whether the tendency to look at mouths is stronger amongst older men compared to older women, and (2) to examine whether men’s mouth looking correlates with better emotion recognition. METHOD: We examined the emotion recognition abilities, and spontaneous gaze patterns of young (n = 60) and older (n = 58) males and females as they labelled emotion faces. RESULTS: Older men spontaneously looked more to mouths than older women, and older men’s looking at mouths correlated with their emotion recognition, whereas women’s looking at eyes correlated with their emotion recognition. DISCUSSION: The findings are discussed in relation to a growing body of research suggesting both age and gender differences in response to emotional stimuli, and the differential efficacy of mouth and eyes looking for men and women.

OBJECTIVE Given the urgent need to develop effective programs that improve the ability for adolescents to achieve metabolic control equivalent to programs studied in the Diabetes. Control and Complications Trial, we have undertaken a clinical trial to determine if a behavioral intervention (coping skills training [CST]) combined with intensive diabetes management can improve metabolic control and quality of life in adolescents implementing intensive therapy regimens. RESEARCH DESIGN AND METHODS A total of 65 youths between the ages of 13 and 20 years, who elected to initiate intensive insulin therapy, were randomly assigned to one of two groups: the intensive management with CST group and the intensive management without CST group. CST consists of a series of small group efforts designed to teach adolescents the coping skills of social problem-solving, social skills training, cognitive behavior modification, and conflict resolution. Data were collected at pre-intervention and at 3 months following the use of the Self-Efficacy for Diabetes scale, Children's Depression Inventory, Issues in Coping with IDDM scale, and the Diabetes Quality of Life: Youth scale. Clinical data (HbA1c, adverse effects) were collected monthly. RESULTS The experimental and control groups were comparable on all measures at baseline. Results show that adolescents who received CST had lower HbA1c and better diabetes self-efficacy and were less upset about coping with diabetes than adolescents receiving intensive management alone. In addition, adolescents who received the CST found it easier to cope with diabetes and experienced less of a negative impact of diabetes on quality of life than those who did not receive CST. CONCLUSIONS CST is useful in improving not only an adolescent's metabolic control, but also their quality of life. As more pediatric providers aim for improved control, in adolescents with diabetes, the addition of this behavioral intervention may be helpful in achieving metabolic and life goals.

The purpose of this study was to pilot test the feasibility and efficacy of a novel method of teaching camp counselors hypoglycemia management.During orientation, counselors were assigned to the experimental (n= 21) or control (n= 15) group and received hypoglycemia education. The experimental group received supplemental education with a human patient simulator (HPS).Baseline demographics, knowledge, and self-efficacy were similar between groups. The experimental group had a significantly larger gain in diabetes knowledge than the control group. Within-participant change in self-efficacy did not differ by group. We observed a significant effect modification, with larger treatment-related differences in the small subgroup with no previous diabetes exposure.This feasibility study demonstrated the ease of teaching diabetes management to camp counselors using HPS.

Purpose To purpose of the pilot study was to evaluate the use of a pediatric human patient simulator (HPS) to teach parents diabetes management for their children newly diagnosed with type 1 diabetes, referred to as Parent Education Through Simulation–Diabetes. Methods A focus group study and 2 pilot studies (1-group study and a randomized 2-group study) were used to develop and test a teaching intervention. Parents were recruited from the Pediatric Diabetes Clinic at UMass Memorial Medical Center. A brainstorming group (n = 6) discussed the simulator concept and what modifications would be necessary to enhance parent teaching; the authors also developed the initial hypoglycemia and hyperglycemia teaching vignettes. Two focus groups (n = 13) discussed the acceptance of using a simulator and the timing and content of the teaching sessions. Based on their recommendations, a 1-group pretest-posttest pilot was conducted with parents (n = 10) receiving hypoglycemia education enhanced with the HPS, followed by a randomized 2-group pilot study (n = 16). Findings The focus group participants enthusiastically supported the use of the pediatric HPS after diagnosis and made recommendations for the timing and content of the teaching sessions. Major findings from the pilot work included (1) successful recruitment of 16 participants from only 1 site within 6 weeks, (2) instrument reliability demonstrated for all scales, and (3) mean change from baseline in the predicted direction for all measures. Conclusions The HPS has the potential of providing parents an innovative means of learning diabetes management through visualization during the early months after diagnosis and so warrants a powered study to determine its efficacy.

English as a Second Language programs serve large foreign-born populations in the US with elevated risks of tuberculosis (TB), yet little is known about TB perceptions in these settings. Using a community-based participatory research approach, we elicited perceptions about TB among immigrant and refugee learners and staff at a diverse adult education center. Community partners were trained in focus groups moderation. Ten focus groups were conducted with 83 learners and staff. Multi-level, team-based qualitative analysis was conducted to develop themes that informed a model of TB perceptions among participants. Multiple challenges with TB control and prevention were identified. There were a variety of mis-perceptions about transmission of TB, and a lack of knowledge about latent TB. Feelings and perceptions related to TB included secrecy, shame, fear, and isolation. Barriers to TB testing include low awareness, lack of knowledge about latent TB, and the practical considerations of transportation, cost, and work schedule conflicts. Barriers to medication use include suspicion of generic medications and perceived side effects. We posit adult education centers with large immigrant and refugee populations as excellent venues for TB prevention, and propose several recommendations for conducting these programs. Content should dispel the most compelling misperceptions about TB transmission while clarifying the difference between active and latent disease. Learners should be educated about TB in the US and that it is curable. Finally, TB programs that include learners and staff in their design and implementation provide greater opportunity for overcoming previously unrecognized barriers.

The purpose of this study was to test the efficacy of a social support intervention with parents of children13 years old newly diagnosed with type 1 diabetes mellitus (T1DM).For this randomized, controlled clinical trial, 10 parent mentors of children diagnosed with T1DMor=1 year and 60 parent participants were recruited from 2 pediatric diabetes centers. Mentors were trained to provide social support (home visits and phone calls) for 12 months to families in the experimental arm (32 mothers). Control group parents (28 mothers) received the phone number of an experienced parent (not trained to give social support) to call as needed. Findings Mothers in the experimental and control arms differed at baseline only in birth order of the child with T1DM. The 2 groups did not differ significantly at 3, 6, or 12 months in parent concern, confidence, worry, impact on the family, or perceived social support. Mothers in the experimental arm identified the parent mentor as someone they would seek for advice and issues regarding growth and development, sleep, eating habits, and identification of community agencies. Parent mentors consistently referred mothers to health care providers for advice on medications and treatments but helped them incorporate this advice into day-to-day management.Mothers in the experimental arm valued the mentors' help in adjusting to the diagnosis, but this value was not measured by the study instruments. Focus group research is under way to clarify the concept of parent mentor social support and to develop a social support measurement tool.

Hepatitis C Treatment Experiences and Decision-Making Among Patients Living with HIV Infection Abstract Hepatitis C infection is a major problem for approximately 250,000 HIV-infected persons in the United States. Although HIV infection is well controlled in most of this population, they suffer liver-associated morbidity and mortality. Conversely, HCV treatment uptake remains quite low (15–30%). Therefore, the purpose of this qualitative study was to explore HCV treatment experiences and decision-making in adults with HIV infection. The study sample included 39 co-infected adults, 16 in the HCV-treated cohort (who were interviewed up to 3 times) and 23 in the HCV-non-treatment cohort. Analysis of interviews identified 2 treatment barriers (fears and vicarious experiences) and 4 facilitating factors (experience with illness management, patient-provider relationships, gaining sober time, and facing treatment head on). Analysis of these data also revealed a preliminary model to guide intervention development and theoretical perspectives. Ultimately, research is urgently needed to test interventions that improve HCV evaluation and treatment uptake among HIV-infected patients.

This study compared young and older adults' ability to recognize bodily and auditory expressions of emotion and to match bodily and facial expressions to vocal expressions. Using emotion discrimination and matching techniques, participants assessed emotion in voices (Experiment 1), point-light displays (Experiment 2), and still photos of bodies with faces digitally erased (Experiment 3). Older adults' were worse at least some of the time in recognition of anger, sadness, fear, and happiness in bodily expressions and of anger in vocal expressions. Compared with young adults, older adults also found it more difficult to match auditory expressions to facial expressions (5 of 6 emotions) and bodily expressions (3 of 6 emotions).

The feasibility and effectiveness of a distance-based quality improvement model were examined in a cohort of Pediatric Research in Office Settings (PROS) practices, with the goal of improving immunization rates and practitioner behaviors and attitudes. Of an initially assessed 82 practices, 29 with baseline rates of ≤88% for children 8 to 15 months of age were randomized into year-long paper-based education or distance-based quality improvement intervention groups. Outcomes were utility/helpfulness of quality improvement modalities, immunization rate change, and behavior/attitude change. Quality improvement participants attended approximately 75% of monthly conference calls but used the quality improvement Listserv and Web site infrequently (mean 1.09 and 0.92 uses, respectively). Helpfulness ratings of quality improvement modalities mirrored usage. Analyses revealed a 4.9% increase in quality improvement group immunization rates ( P = .061), a 0.8% education group increase ( P = .752), and a 4.1% difference between groups ( P = .261). More quality improvement practices adopted systems identifying children behind in immunizations. A distance-based quality improvement model is feasible and may improve immunization rates.

We compared young and healthy older adults' ability to rate photos of faces and situations (e.g., sporting activities) for the degree of threat they posed. Older adults did not distinguish between more and less dangerous faces to the same extent as younger adults did. In contrast, we found no significant age differences in young and older adults' ability to distinguish between high- and low-danger situations. The differences between young and older adults on the face task were independent of age differences in older adults' fluid IQ. We discuss results in relation to differences between young and older adults on emotion-recognition tasks; we also discuss sociocognitive and neuropsychological (e.g., amygdala) theories of aging.

Objective: To compare the frequency of venous thromboembolism (VTE) in patients examined during 1992-1995 with those examined during 1999-2003. Design: A comprehensive review of the charts of all patients admitted betweenlate 1999 and early 2003 for rehabilitation after spinal cord injury. Only records, including evidence for objective testing for VTE (ultrasound, venography, lung scanning) were included, and patients having inferior vena cava filter placement or previous VTE were excluded. Analysis variables included type and location of spinal cord injury, American Spinal Injury Association classification, concomitant injuries, surgical procedures, complications, preexisting illnesses, and use of antithrombotic prophylaxis. Using univariate optimal discriminant analysis, data from the current group of patients were compared with a previous study of 243 subjects examined between 1992 and 1995. Results: The current sample consisted of 76 persons with acute spinal cord injury, of whom six had VTE (7.9%). As compared with the frequency of VTE in the previous patient sample (21%), this represented a significant decrease (P < 0.01). The major differences between the current and previous patient samples were a decrease in the use of unfractionated heparin (15.8% vs. 56.8%, P < 0.0001) and an increase in the use of low molecular weight heparin (81.6% vs. 59.7%, P < 0.0001). Conclusions: VTE has been a common and occasionally lethal complication in persons with spinal cord injury. The recent switch from unfractionated heparin to low molecular weight heparin for the prevention of VTE has coincided with a decrease in the frequency of this complication in patients with spinal cord injury.

Purpose: To describe the experiences of parents managing the type 1 diabetes of their young children using an insulin pump. Design: Qualitative description, based on principles of naturalistic inquiry. Methods: Open-ended, in-depth interviews were conducted with 21 mothers and fathers of 16 children less than 12 years old in the eastern part of the United States. The children had been on pump treatment from 3 to 36 months. Data were managed and analyzed using qualitative content analysis. Findings: Parents reported becoming comfortable with pump management 10 days to 2-3 months after the child started using it. During this adjustment period, they had to “rethink” how they managed the disease. Although using the pump required vigilance and more frequent glucose checking than did multiple daily injections (MDI), the pump provided better glucose control, easier disease management, fewer variables to manipulate, and more flexible meal times. A few parents were tempted to more tightly control the child's glucose levels, which could potentially increase parental stress. Fathers were actively involved in the day-to-day management and benefited from opportunities to participate in the child's care. They emphasized the importance of practicing the tasks associated with diabetes management to improve their confidence when caring for the child alone. Parents reported that everyone in the family experienced more freedom, flexibility, and spontaneity in their daily lives. Conclusions: For this sample of parents, the health and management benefits of their children's use of the insulin pump outweighed the adjustment challenges involved in changing from MDI.

Background. This study evaluated the effectiveness of three smoking cessation interventions for this population: (1) modified usual care (UC); (2) brief advice (A); and (3) brief advice plus more extended counseling during and after hospitalization (A + C). Methods. Smokers (2,095) who were in-patients in four hospitals were randomly assigned to condition. Smoking status was ascertained via phone interview 7 days and 12 months post-discharge. At 12 months, reports of abstinence were validated by analysis of saliva cotinine. Intent to treat analyses were performed. Results. At 7-day follow-up, 24.2% of participants reported abstinence in the previous 7 days. There were no differences between conditions. At 12-month follow-up, self-reported abstinence was significantly higher in the A + C condition (UC (15.0%) vs. A (15.2%) vs. A + C (19.8%)). There was no significant difference among conditions in cotinine-validated abstinence, however (UC (8.8%) vs. A (10.0%) vs. A + C (9.9%)). Conclusions. These interventions for hospital in-patients did not increase abstinence rates. Features of the study that might have contributed to this finding were the inclusiveness of the participation criteria, the fact that pharmacological aids were not provided, and a stage-matching approach that resulted in less intensive counseling for participants unwilling to set a quit date.

Until recently, theory of mind abilities have received little attention beyond the childhood years. However, pioneering work carried out by Happe, Winner, and Brownell (1998) has opened the doors on a new and exciting area of research that examines theory of mind abilities in later years. Happe et al. reported that theory of mind performance was superior in the elderly. Yet, in direct contrast to these findings, Maylor, Moulson, Muncer, and Taylor (2002) report a decline in theory of mind abilities with advancing years. We used Happe et al.'s task and, like Maylor et al., found a decline in theory of mind abilities in the elderly. Yet this deficit was related to a decline in fluid abilities. We then examined whether deficits in social understanding in the elderly could also be independent of fluid abilities. We used two new tasks; identifying emotions from still photos and identifying emotions and cognitions from video clips. Again we found a decline in social understanding in the elderly, and in this case, the decline was independent of changes in fluid abilities.

Objective To determine whether pediatricians and dietitians can implement an office-based obesity prevention program using motivational interviewing as the primary intervention. Design Nonrandomized clinical trial. Fifteen pediatricians belonging to Pediatric Research in Office Settings, a national practice-based research network, and 5 registered dietitians were assigned to 1 of 3 groups: (1) control; (2) minimal intervention (pediatrician only); or (3) intensive intervention (pediatrician and registered dietitian). Setting Primary care pediatric offices. Participants Ninety-one children presenting for well-child care visits met eligibility criteria of being aged 3 to 7 years and having a body mass index (calculated as the weight in kilograms divided by the height in meters squared) at the 85th percentile or greater but lower than the 95th percentile for the age or having a normal weight and a parent with a body mass index of 30 or greater. Interventions Pediatricians and registered dietitians in the intervention groups received motivational interviewing training. Parents of children in the minimal intervention group received 1 motivational interviewing session from the physician, and parents of children in the intensive intervention group received 2 motivational interviewing sessions each from the pediatrician and the registered dietitian. Main Outcome Measure Change in the body mass index–for-age percentile. Results At 6 months' follow-up, there was a decrease of 0.6, 1.9, and 2.6 body mass index percentiles in the control, minimal, and intensive groups, respectively. The differences in body mass index percentile change between the 3 groups were nonsignificant ( P = .85). The patient dropout rates were 2 (10%), 13 (32%), and 15 (50%) for the control, minimal, and intensive groups, respectively. Fifteen (94%) of the parents reported that the intervention helped them think about changing their family's eating habits. Conclusions Motivational interviewing by pediatricians and dietitians is a promising office-based strategy for preventing childhood obesity. However, additional studies are needed to demonstrate the efficacy of this intervention in practice settings.

Research suggests that a person's emotion recognition declines with advancing years. We examined whether or not this age-related decline was attributable to a tendency to overlook emotion information in the eyes. In Experiment 1, younger adults were significantly better than older adults at inferring emotions from full faces and eyes, though not from mouths. Using an eye tracker in Experiment 2, we found young adults, in comparison with older adults, to have superior emotion recognition performance and to look proportionately more to eyes than mouths. However, although better emotion recognition performance was significantly correlated with more eye looking in younger adults, the same was not true in older adults. We discuss these results in terms of brain changes with age.

A descriptive study of the rate of learning socially acceptable (independent and dependent) bowel and bladder management for the child with myelodysplasia was done. All those children born with myelodysplasia and being followed in an interdisciplinary clinic were included (N = 525). Ages ranged from birth to 18+ years. They were classified into one of three categories according to the level of their lesion: a) sacral, b) low lumbar, or c) high lumbar or thoracic. Data were analyzed by the Breslow and X2 statistical techniques. The children with high lumbar and thoracic level lesions acquired independence more slowly than those with lower level lesions (p =. 0008). Development of independence was started for children with low lesions as early as 4 to 7 years of age; however, it was not until 10 to 11 years of age for those with high lesions. By 7 to 9 years of age, 50 percent of the children with low lesions had achieved socially acceptable urine collection but were still dependent for stool collection; th...

In a work-site weight control program using a self-motivational program of financial incentives implemented through payroll deduction, 131 university employees chose weight loss goals (0 to 60 lb) and incentives (+5 to +30) to be deducted from each paycheck for six months. Return of incentive money was contingent on progress toward weight goals. Participants were assigned randomly to one of four protocols, involving group educational sessions v self-instruction only and required v optional attendance at weigh-ins and sessions. Overall, dropout rates (21.4%) and mean weight loss (12.2 lb) were encouraging, especially compared with those of other work-site programs. Weight loss was positively associated with attendance at weigh-ins and educational sessions. However, requiring attendance did not increase program effectiveness and seemed also to discourage enrollment among men. The weight control program was equally effective when offered with professionally led educational sessions or when accompanied by self-instructional materials only.

Two patients with advanced lymphoma, chronic cold agglutinin disease refractory to conventional therapy and severe, progressive anemia were treated with exchange plasma transfusion. Both experienced significant reduction in titers. The first patient, in whom the procedure was done manually, died with widespread lymphoma without achieving apparent clinical benefit. The second patient was exchanged using the Aminco Celltrifuge, with improvement in in vitro compatibility tests and transfusion tolerance. The technical details of continuous-flow centrifugation exchange plasma transfusion are described.