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Purpose - The current study compares the relative strength of associations of different adherence measures with glycemic control in adolescents with type 1 diabetes, while highlighting the challenges in using more objective measures (i.e., glucometer data).
Methods - Adolescents with type 1 diabetes ( = 149) and their caregivers completed a questionnaire measure assessing adolescents' adherence (Self-Care Inventory (SCI)) to the diabetes regimen. Adolescents' glucometers were downloaded to determine average blood glucose checks per day, as an objective measure of adherence. A measure of glycemic control (hemoglobin A1c (HbA1c)) was obtained as part of adolescents' regular clinic visits.
Results - Adolescents' self-reported adherence to the treatment regimen was more strongly correlated with HbA1c than caregivers' reports of adherence. In multivariate analyses, both adolescents' self-report of adherence and average blood glucose checks per day (obtained via a glucometer) were significant predictors of HbA1c. Challenges to obtaining glucometer data were identified.
Conclusions - The findings highlight adolescents' self-report of adherence using the SCI as a brief and meaningful measure to understand and improve adolescents' glycemic control, particularly when glucometer data is difficult to obtain.
Sustained parental involvement in diabetes management has been generally advised to counteract the deteriorating adherence and glycemic control often seen during adolescence, yet until recently, little attention has been given to the optimal amount, type, and quality of parental involvement to promote the best health outcomes for adolescents with type 1 diabetes (T1D). This review synthesizes research regarding the involvement of caregivers-primarily mothers and fathers-of youth with T1D, with a focus on biopsychosocial outcomes. The recent literature on parental involvement in diabetes management highlights a shift in focus from not only amount but also the types (e.g., monitoring, problem-solving) and quality (e.g., warm, critical) of involvement in both mothers and fathers. We provide recommendations for ways that both parents can remain involved to facilitate greater collaboration in shared direct and indirect responsibility for diabetes care and improve outcomes in youth with T1D.
PURPOSE - The purpose of the current study was to pilot-test a positive psychology intervention to improve adherence to diabetes management in adolescents with type 1 diabetes.
METHODS - A total of 39 adolescents (ages, 13-17 years) with type 1 diabetes and their caregivers were randomized to a positive psychology intervention (n = 20) or an attention control (education) intervention (n = 19). The intervention condition used positive psychology exercises (eg, gratitude, self-affirmation), small gifts, and parent affirmations to boost positive affect. Outcomes included frequency of blood glucose monitoring, quality of life, and glycemic control.
RESULTS - No main effects for treatment were observed at the 6-month follow-up. However, there was a significant association between adolescents' levels of positive affect and measures of adherence, including self-report and meter downloads of glucose monitoring.
CONCLUSIONS - The results from the current study support the assertion that positive affect in the context of diabetes education is an important factor to consider in adolescents with type 1 diabetes.
© 2014 The Author(s).
PURPOSE - To assess the safety of psychotropic medication use in children and adolescents, it is critical to be able to identify suicidal behaviors from medical claims data and distinguish them from other injuries. The purpose of this study was to develop an algorithm using administrative claims data to identify medically treated suicidal behavior in a cohort of children and adolescents.
METHODS - The cohort included 80,183 youth (6-18 years) enrolled in Tennessee's Medicaid program from 1995-2006 who were prescribed antidepressants. Potential episodes of suicidal behavior were identified using external cause-of-injury codes (E-codes) and ICD-9-CM codes corresponding to the potential mechanisms of or injuries resulting from suicidal behavior. For each identified episode, medical records were reviewed to determine if the injury was self-inflicted and if intent to die was explicitly stated or could be inferred.
RESULTS - Medical records were reviewed for 2676 episodes of potential self-harm identified through claims data. Among 1162 episodes that were classified as suicidal behavior, 1117 (96%) had a claim for suicide and self-inflicted injury, poisoning by drugs, or both. The positive predictive value of code groups to predict suicidal behavior ranged from 0-88% and improved when there was a concomitant hospitalization but with the limitation of excluding some episodes of confirmed suicidal behavior.
CONCLUSIONS - Nearly all episodes of confirmed suicidal behavior in this cohort of youth included an ICD-9-CM code for suicide or poisoning by drugs. An algorithm combining these ICD-9-CM codes and hospital stay greatly improved the positive predictive value for identifying medically treated suicidal behavior.
Copyright © 2013 John Wiley & Sons, Ltd.
Neuroimaging research in adults has consistently found that differential perception of race is associated with increased amygdala activity. We hypothesized that such neural biases unlikely reflect innate processes but instead emerge over development. In the current study, we used fMRI to examine the neurodevelopmental trajectory of the amygdala in response to race across childhood and adolescence ranging from 4 to 16 years. Thirty-two youths viewed African American and European American faces during a functional brain scan. Results suggest that differential amygdala response to African American faces does not emerge until adolescence, reflecting the increasing salience of race across development. In addition, greater peer diversity was associated with attenuated amygdala response to African American faces, suggesting that intergroup racial contact may reduce the salience of race.
This study describes the ways in which two African-American churches discuss adolescent sexual health topics. Six focus groups were conducted in two churches in Flint, Michigan, that reported no formal sexual health programming for their congregants. Three themes emerged to highlight the different perspectives about the role of churches in adolescent sexual decision-making and sexual health education: (1) churches as sources of sexual information, (2) churches as complex communities, and (3) recommendations for sexual education in churches. Participant responses suggest that churches can and should serve a resource for sexual health information. Implications for practice and research are discussed.
Research on youth civic engagement focuses on individual-level predictors. We examined individual- and school-level characteristics, including family affluence, democratic school social climate and perceived neighborhood social capital, in their relation to civic engagement of 15-year-old students. Data were taken from the 2006 World Health Organization Health Behaviour in School-aged Children survey. A sample of 8,077 adolescents in 10th grade from five countries (Belgium, Canada, Italy, Romania, England) were assessed. Multilevel models were analyzed for each country and across the entire sample. Results showed that family affluence, democratic school climate and perceived neighborhood social capital positively related to participation in community organizations. These links were stronger at the aggregate contextual than individual level and varied by country. Canadian youth participated most and Romanian youth least of the five countries. Gender predicted engagement in two countries (girls participate more in Canada, boys in Italy). Findings showed significant contributions of the social environment to adolescents' engagement in their communities.
The present study aims to develop an integrative model that links neighborhood behavioral opportunities and social resources (neighborhood cohesion, neighborhood friendship and neighborhood attachment) to prosocial (sharing, helping, empathic) behavior in early adolescence, taking into account the potential mediating role of perceived support of friends. Path analysis was used to test the proposed theoretical model in a sample of 1,145 Italian early adolescents (6th through 8th graders). More perceived opportunities and social resources in the neighborhood are related to higher levels of adolescent prosocial behavior, and this relationship is partially mediated by perceived social support from friends. The results offer promising implications for future research and intervention programs that aim to modify social systems to improve child and adolescent social competencies.
OBJECTIVE - Describe intervention processes associated with an Internet self-management problem solving program for adolescents with type 1 diabetes, and relate participant characteristics to program use.
METHODS - Forty-one adolescents with type 1 diabetes, aged 13-17, participated in an Internet intervention.
RESULTS - Participants reported psychosocial self-management barriers related to social issues (45%), time pressures (22%), and emotions (25%). Most adolescents (76%) completed the two guided problem solving cycles, and most (97%) problems were appropriate and specific to diabetes. Of the 61 diabetes problems reported, 92% were mostly or completely solved. Baseline hemoglobin A1c, diabetes duration, and age were not related to online activities, however females posted more often to the forum (U=130.0, Z=2.13, p=.033). The majority of parents (87%) interacted with their child about the website.
CONCLUSION - Adolescents experience psychosocial barriers to self-management that can be addressed by teaching problem solving via the Internet.
PRACTICE IMPLICATIONS - An Internet self-management problem solving program with minimal external support provides a viable option for diabetes clinics to improve pediatric diabetes outcomes.
Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
The Adolescents, Life Context, & School project was developed in a suburban, residential area of Padova, Italy, and involved three classes of 12-year-old children. Across three months, children observed, documented, and talked about their own life contexts in order to voice problems to decision makers. Both teachers and council members played key roles in supporting the project and the children's work. Limited quantitative results showed an increase in reported neighborhood civic responsibility compared to a control group of students. Qualitative evaluation results demonstrated strong interest. The involvement by teachers, local government, and students in the project led to real actions and improvements in the neighborhood and school and to the creation of an official youth affairs council. The program provides a model for service-learning and organized student civic engagement.