Exploring the role of motivational interviewing in adolescent patient-provider communication about type 1 diabetes

Type 1 diabetes (T1D) is one of the most common pediatric chronic illnesses. Glycemic control among patients with T1D often deteriorates during adolescence; yet little is known about the most effective way for providers to communicate with adolescents to prevent this decline. Given the importance of effective communication, examination of effective patient-provider communication strategies is needed. The current investigation used Motivational Interviewing (MI) as a framework to help characterize naturally-occurring adolescent patient-provider communication in medical encounters and examined the relations between provider communication and T1D self-management and control. Participants were five pediatric endocrine providers and 55 adolescents with T1D (49% female; 76% White; M age= 14.8 years, SD= 1.6). Mean T1D duration was 7.9 years (SD= 3.9) and mean baseline HbA1c was 8.58% (SD= 1.4). Adolescents and caregivers completed surveys related to diabetes self-management and psychosocial functioning at a routine endocrinology visit and again at one and three months post-baseline. Medical encounters were audio-recorded and coded. HbA1c was obtained via medical chart review at baseline, three, and six month appointments. Hierarchical multiple regressions revealed that, after controlling for prior MI training (providers) and adolescent baseline HbA1c, age, and race, use of MI non-adherent behavior (e.g., confronting, persuading) was associated with 1) poorer three month HbA1c, F(5,45)= 11.19, p \u3c .001; R2 = .554 and 2) worse adolescent diabetes adherence, F(5, 46)= 9.86, p \u3c .001; R2= .517. MI non-adherent behavior emerged as a significant predictor in each model, t(45)= 2.13,p = .038, β = .242 and t(46) = -2.39, p= .021, β= -.300, respectively. A mediation analysis determined that patient self-efficacy for diabetes self-management mediated the relation between the use of these MI non-adherent behaviors and lower diabetes adherence. In TalkT1me, providers’ overreliance on persuasion and confronting adolescents about the risks of non-adherence was paradoxically associated with poorer glycemic control and adherence. Certain communication techniques that are inconsistent with MI, like confronting or persuading, appear to have a negative impact on diabetes self-care and HbA1c. Results from this evaluation of naturally occurring communication can help guide targeted training efforts to enhance communication and improve diabetes self-care with these vulnerable patients

Adolescent Overweight, Obesity and Chronic Disease-Related Health Practices: Mediation by Body Image

Background/Aims: To examine whether body image mediates the association between overweight/obesity and chronic disease-related health practices (CDRHP), including lack of physical activity (PA), infrequent breakfast consumption (IBC), screen-based media use (SBM), and smoking. Methods: The 2006 Health Behaviors in School-Age Children survey was administered to a nationally representative sample of US students (n = 8,028) in grades 6-10 (mean age = 14.3 years). Outcome variables included self-reported measures of PA, SBM, IBC, and smoking. Body image was assessed with 5 items from the Body Investment Scale (α = 0.87) asking for agreement/disagreement with statements about one's body. Stratifying on gender, an initial regression model estimated the association between overweight/obesity and CDRHP. Mediation models that included body image were then compared to the initial model to determine the role of body image in the relationship between overweight/obesity and CDRHP. Results: Among boys, body image mediated the relationships of overweight/obesity with SBM, and of obesity with IBC. Among girls, it mediated the relationships of obesity with PA, IBC, and smoking, and of overweight with SBM. Conclusion: As the prevalence of overweight/obesity among adolescent boys and girls remains high, efforts to improve their body image could result in less frequent engagement in CDRHP

Family Density and SES Related to Diabetes Management and Glycemic Control in Adolescents With Type 1 Diabetes

Objective Youth with Type 1 diabetes (T1D) from single-parent families have poorer glycemic control; a finding confounded with socioeconomic status (SES). Family density (FD), or youth:adult ratio, may better characterize family risk status. Methods Structural equation modeling assessed the relation of single-parent status, SES, and FD to parenting stress, diabetes-related conflict, parental monitoring, adherence, and glycemic control using cross-sectional parent and youth data (n = 257). Results Single-parent status exhibited similar relations as SES and was removed. Lower FD was associated with better glycemic control (β = −.29, p = .014) via less conflict (β = .17, p = .038) and greater adherence (β = −.54, p < .001). Conclusions Beyond SES, FD plays a significant role in adherence and glycemic control via diabetes-related conflict. In contrast, the effects of single-parent status were indistinguishable from those of SES. FD provides distinct information related to adolescent glycemic control

Home Food Environment Changes and Dietary Intake during an Adolescent Behavioral Weight Loss Intervention Differ by Food Security Status

Behavioral weight loss (BWL) for pediatric obesity includes guidance on improving the home food environment and dietary quality; yet food insecurity presents barriers to making these changes. This study examined if home food environment, dietary quality, energy intake, and body weight changes during adolescent obesity treatment differed by food security status, and if changes in the home food environment were associated with changes in dietary quality and energy intake by food security status. Adolescents (n = 82; 13.7 ± 1.2 years) with obesity participated in a 4-month BWL treatment. Food insecurity, home food environment (Home Food Inventory [HFI]), dietary quality (Healthy Eating Index [HEI]), energy intake, and body mass index (BMI) were assessed at baseline and post-treatment. A reduced obesogenic home food environment and improved dietary quality were observed for food secure (ps 0.05) (mean difference, HFI: −6.6 ± 6.4 vs. −2.4 ± 7.4; HEI: 5.1 ± 14.4 vs. 2.7 ± 17.7). Energy intake and BMI decreased for adolescents in food secure and insecure households (ps < 0.03) (mean difference; energy intake: −287 ± 417 vs. −309 ± 434 kcal/day; BMI: −1.0 ± 1.4 vs. −0.7 ± 1.4). BWL yielded similar reductions in energy intake and body weight yet did not offer the same benefits for improved dietary quality and the home food environment for adolescents with food insecurity

Effect of a High-Intensity Dietary Intervention on Changes in Dietary Intake and Eating Pathology during a Multicomponent Adolescent Obesity Intervention

Concerns remain about dietary changes during pediatric obesity treatment and eating pathology, which have not been investigated. This secondary data analysis from a randomized clinical trial examined associations between adolescents’ changes in energy intake and diet quality during obesity treatment with post-treatment eating pathology. Adolescents (N = 82: 13.7 ± 1.2 y, 34.9 ± 7.0 kg/m2, 63.4% female, 46.3% black) received TEENS+, a 4-month multicomponent intervention. TEENS+ provided individualized dietary goals (1200–1800 kcal/day; number of “Go” foods/day (low-energy, high-nutrient-dense foods)). At 0 and 4 months, 3-day food records assessed energy intake and diet quality (Healthy Eating Index 2015 (HEI-2015)). Two HEI-2015 subscores were created: components to increase (increase), and components to limit (decrease). The Eating Disorder Examination Questionnaire measured eating pathology (total score and subscales: restraint; and eating, weight, and shape concern). Corrected p-values are reported as q-values. Energy intake decreased (−292 ± 418 kcal/day; q &lt; 0.001), while diet quality improved during treatment (total HEI-2015 (4.5 ± 15.1; q = 0.034) and increase (3.3 ± 9.4; q = 0.011)). Restraint increased (+0.6 ± 1.4; q &lt; 0.001), whereas shape (−0.5 ± 1.3; q = 0.004) and weight (−0.5 ± 1.4; q = 0.015) concerns decreased. Greater decreases in energy intake were associated with greater restraint post-treatment (F = 17.69; q &lt; 0.001). No other significant associations were observed. Changes in adolescents’ dietary intake during obesity treatment were unrelated to increased shape, weight, or eating concerns post-treatment

Studies on heavy metals effects on Mytilus galloprovincialis sperm chromatin proteins and on DNA

Heavy metal pollution has become one of the most serious environmental problems in the world that brought threat to human health and ecological security. To monitor sea levels of heavy metals we used as specific bioindicator Mytilus galloprovincialis whose sperm chromatin is organized mainly by three protamine-like proteins (PLII, PLIII and PLIV). These proteins protect DNA from a variety of potentially dangerous reactive species but chromatin packaging doesn’t protect DNA from metal ion-dependent damage in the presence of hydroxyl radicals. We report the effects induced by Cu2+, Ni2+ and Cd2 ions on DNA and on Mytilus galloprovincialis’ PLII and PLIII. Self-association ability of PLII and PLIII mediated by Cd2+, Ni2+ and Cu2+ show that Cd2+ causes only PLII aggregation to a greater extend respect to Ni2+ that induces a mild aggregation of both PLII and PLIII; Cu2+, instead, doesn’t produce any type of aggregates. In vivo studies show that these heavy metals affect PLII, PLIII and PLIV state and properties. While nickel produces an increase of DNA binding affinity for both PLII and PLIII cadmium causes a decrease of PLII DNA binding affinity but an increase for PLIII. Copper and cadmium promote hydrogen peroxide damage of DNA also in the presence of protamine-like proteins while nickel doesn’t. All these effects can lead an anomalous chromatin packaging and a reduction of the reproductive fitness in Mytilus galloprovincialis and other organisms exposed to the same toxicants

Effects of copper and nickel on protamine like and on DNA oxidative damage in Mytilus galloprovincialis

In sperm cells, DNA is complexed with sperm nuclear basic proteins (SNBPs) to form chromatin. Although SNBPs protect DNA from a variety of potentially dangerous reactive species, such as hydroxyl radicals (•OH), chromatin packaging doesn’t protect DNA from metal ion-dependent damage in the presence of hydroxyl radicals. We report the effects induced by Cu2+ and Ni2+ ions on DNA and Mytilus galloprovincialis’ protamine-like II and III. Protamine-like III acquires proteinase k digestion resistance in the presence of copper and not in the presence of nickel; PLII, in contrast with PLIII, is sensitive to proteinase k digestion in presence of both metals. Further, copper promotes hydrogen peroxide damage of DNA also in the presence of PL-types while nickel promoting PL-types aggregation enhances DNA compactness and protection. Nickel in fact, in contrast to copper, increases PLII and PLIII DNA binding affinity. All these effects can lead an anomalous chromatin packaging and, therefore, a reduction of Mytilus galloprovincialis’ reproductive fitness and of other organisms exposed to the same toxicants

New insights into protamine-like component organization in Mytilus galloprovincialis sperm chromatin

We have analyzed Mytilus galloprovincialis’ sperm chromatin which consists of three sperm nuclear basic proteins of the PL-type: PL-II, PL-III and PL-IV, in addition to a residual amount of the four core histones. The knowledge of Mytilus galloprovincialis’ sperm chromatin structure, the organization of the PL-type component in chromatin and their interactions with DNA is of considerable interest because these organisms are largely utilized as bioindicator of marine pollution that could affect its state. Our results obtained by micrococcal nuclease digestion in combination with salt fractionation suggest the existence of a likely unusual organization in which there would be a more accessible location of PL-II/PL-IV when compared to PL-III and core histones. Further we used electrophoretic mobility shift assay in order to define DNA binding mode of PLII and PLIII and turbidimetric assays to determine their self-association ability in the presence of sodium phosphate. On the base of our results we propose a model of Mytilus galloprovincialis’ sperm chromatin organization that could be useful in order to develop chromatin-based genotoxicity tests in pollution biomonitoring programs

Antibacterial, antifungal and antitumor activity of Mytilus galloprovincialis’ protamine-like

We have studied the antibacterial, antifungal and antitumor activity of Mytilus galloprovincialis’ protamine-like. Nine bacterial strains were employed. They included two Gram-positive and seven Gram-negative bacteria. The same clinically isolated (CI) bacterial strains were used to compare the sensitivity to these proteins. Antifungal tests were done on 3 strains of fungi including: 1 potentially pathogenic yeast (Candida albicans CI) and 2 filamentous phytopathogenic fungi Botrytis cinerea and Rhyzoctonia solani. Mytilus galloprovincialis’ protamine-like inhibited all bacteria strains with different MBC values ranging from 7.8 to 250 µg/mL and resulted active also on some tested bacteria strains that are generally resistant to conventional antibiotics. They showed also a fungistatic effect on all the fungi tested, with MFCs ranging from 16 to 32 µg/mL and cytotoxic effects on RKO colon cancer cells starting from a concentration of protamine-like 15 µg/mL