The role of parent-adolescent attachment in the glycemic control of adolescents with type-1 diabetes

Using Bowlby\u27s attachment theory and family systems theories, this study explored the associations between parent and adolescent reports of adolescent attachment and glycemic control in adolescents with Type 1 diabetes. I hypothesized that more secure attachment would correlate with better diabetes control, as would concordance between parents and adolescents. Method. Thirty-one families recruited from a diabetes treatment center or the Juvenile Diabetes Association completed written self-report questionnaires about adolescent attachment (Inventory of Parent and Peer Attachment (IPPA; Armsden & Greenberg, 1987)), demographic data and diabetes control (hemoglobin A1c, perceived overall control). Adolescents and parents reported on their perceptions of adolescents\u27 attachment to mothers and fathers. Results. Mean HbA1c for the sample was 7.6% (SD= 1.14). Mothers\u27 perceptions of adolescents\u27 attachment were negatively correlated with adolescents\u27 hemoglobin A1c ( r = -.42, p = .022). Neither fathers\u27 perceptions nor adolescents\u27 reports of attachment was significantly correlated with glycemic control. Adolescents\u27 reports of attachment to mothers and fathers were significantly correlated with perceived control. HbA1c was correlated with perceived control of all members. I found no significant differences between mother and father reports of attachment with their adolescent or for male and female adolescents\u27 attachment to either parent. In regression analyses, adolescent differences in reports of mother- and father-attachment ( p = 51, R 2 Δ = .03) and differences in mothers\u27 and fathers\u27 attachment were not significantly associated ( p = .65, R 2 Δ = .10) with perceived control. Adolescent differences in reports of mother- and father-attachment were not associated with perceptions of control, nor were adolescent-mother differences ( p = .19, R 2 Δ = .06), adolescent-father differences, or mother-father differences in perceptions of adolescent attachment ( p = .48, R 2 Δ = .09). Conclusions. Attachment appears to be associated with glycemic control in this population though the mechanisms are unclear. However, mother perceptions of attachment had the strongest associations with control, not adolescent reports. Parents\u27 abilities to be emotionally responsive, engaged, trustworthy, and autonomy supportive, may enable adolescents to manage diabetes more successfully. Further research is needed to understand the mechanisms through which parent reports of adolescent attachment are associated with glycemic control

Improving Safe Opiate Prescribing: Integrating a Certified Alcohol and Substance Abuse Counselor into a Family Medicine Training Practice

At our Family Medicine Center, a training site for Family Medicine residents, family nurse practitioner residents, post-doctoral psychology fellows, pharmacy interns, and marriage and family therapy interns, we have developed policies and procedures to improve patient safety among those patients who are prescribed opioid medications for chronic pain. This includes initiating naloxone training for patients at risk, integrating a Certified Alcohol and Substance Abuse Counselor (CASAC) into a Family Medicine Training Practice, and working with patients to decrease their opiate prescriptions as appropriate to the clinical situation