The Role Of Family Psychosocial Variables In Glucose Control Of Children And Adolescents With Insulin-dependent Diabetes Mellitus: A Six Month Study

The relationship of psychosocial factors to glucose control in persons with Insulin Dependent Diabetes Mellitus (IDDM) is not clearly understood. The present study examined the effects of sources of stress and its mediators and moderators on glucose control in children with IDDM. Forty children with IDDM and their caretakers were followed for a period of six months with data collected at two 3 month intervals (phase 1 and phase 2). The primary caretaker and child provided ratings of sources of general and diabetes related stress. General and diabetes related social support, coping and behavior measures were collected as well as health history and demographic information. Glucose control was measured through an aggregated daily measure, glycosylated hemoglobin levels (GHB) and the number of hypoglycemic reactions.;The results indicated that the children in this study had more internal and external behavior problems than their nonchronically ill peers. It was not clear, however, if the caretakers rated their chronically ill children\u27s behavior in a more negative light, or if the children did have elevated behavior problems relative to the normative sample.;The measures of glucose control were demonstrated to be complementary, rather than redundant indices, and were differentially sensitive to certain psychosocial factors within and across phases of the study. Sources of stress and supportive diabetes related behaviors reported by primary caretaker and child were associated with variability in daily glucose control within phases of the study. Across phases, primary caretaker stress predicted GHB levels; while the daily measure of glucose control predicted primary caretaker stress and nonsupportive diabetes related behaviors.;The age of the child proved to be an important factor in daily glucose control. The younger the child, the more variable the daily glucose control. In addition, there was a moderating effect of the age of the child on primary caretaker sources of stress in the prediction of later daily glucose control.;The across phase analyses revealed preliminary evidence to support the existence of a unidirectional causal relation, with daily glucose control predicting later sources of stress in the primary caretaker and nonsupportive diabetes related behavior. In addition, primary caretaker sources of stress predicted GHB levels. Further examination of the existence of a circular relationship between sources of stress and measures of glucose control (i.e., GHB and daily measure) is warranted.;Although the findings are preliminary, they underscore the importance of using more than one outcome measure when looking at the effects of psychosocial factors on glucose control. The differential sensitivity of the daily glucose measure to certain psychosocial factors was explained by the proposal that the effect of psychosocial factors does not cause a tonic change in glucose control, but rather produces fluctuations that were only reflected in the daily measures of glucose control. Clinical and research implications of the findings were discussed. The limitations of the present study were outlined and future research was proposed

The effects of the HEALTHY study intervention on middle school student dietary intakes

<p>Abstract</p> <p>Background</p> <p>The HEALTHY study was designed to respond to the alarming trends in increasing rates of overweight, obesity, and type 2 diabetes mellitus in youth. The objective of this analysis was to examine the effects of the HEALTHY study on student self-reported dietary intakes (energy, macronutrients and grams consumed of selected food groups).</p> <p>Methods</p> <p>HEALTHY was a cluster-randomized study in 42 public middle schools. Students, n = 3908, self-reported dietary intake using the Block Kids Questionnaire. General linear mixed models were used to analyze differences in dietary intake at the end of the study between intervention and control schools.</p> <p>Results</p> <p>The reported average daily fruit consumption was 10% higher at the end of the study in the intervention schools than in the control schools (138 g or approximately 2 servings versus 122 g, respectively, p = 0.0016). The reported water intake was approximately 2 fluid ounces higher in the intervention schools than in the control (483 g versus 429 g respectively; p = 0.008). There were no significant differences between intervention and control for mean intakes of energy, macronutrients, fiber, grains, vegetables, legumes, sweets, sweetened beverages, and higher- or lower-fat milk consumption.</p> <p>Conclusion</p> <p>The HEALTHY study, a five-semester middle school-based intervention program that integrated multiple components in nutrition, physical education, behavior change, and social marketing-based communications, resulted in significant changes to student's reported fruit and water intake. Subsequent interventions need to go beyond the school environment to change diet behaviors that may affect weight status of children.</p> <p>Clinical Trials Registration</p> <p><a href="http://www.clinicaltrials.gov/ct2/show/NCT00458029">NCT00458029</a></p

Medical Operations Console Procedure Evaluation: BME Response to Crew Call Down for an Emergency

International Space Station (ISS) Mission Operations are managed by multiple flight control disciplines located at the lead Mission Control Center (MCC) at NASA-Johnson Space Center (JSC). ISS Medical Operations are supported by the complementary roles of Flight Surgeons (Surgeon) and Biomedical Engineer (BME) flight controllers. The Surgeon, a board certified physician, oversees all medical concerns of the crew and the BME provides operational and engineering support for Medical Operations Crew Health Care System. ISS Medical Operations is currently addressing the coordinated response to a crew call down for an emergent medical event, in particular when the BME is the only Medical Operations representative in MCC. In this case, the console procedure BME Response to Crew Call Down for an Emergency will be used. The procedure instructs the BME to contact a Surgeon as soon as possible, coordinate with other flight disciplines to establish a Private Medical Conference (PMC) for the crew and Surgeon, gather information from the crew if time permits, and provide Surgeon with pertinent console resources. It is paramount that this procedure is clearly written and easily navigated to assist the BME to respond consistently and efficiently. A total of five BME flight controllers participated in the study. Each BME participant sat in a simulated MCC environment at a console configured with resources specific to the BME MCC console and was presented with two scripted emergency call downs from an ISS crew member. Each participant used the procedure while interacting with analog MCC disciplines to respond to the crew call down. Audio and video recordings of the simulations were analyzed and each BME participant's actions were compared to the procedure. Structured debriefs were conducted at the conclusion of both simulations. The procedure was evaluated for its ability to elicit consistent responses from each BME participant. Trials were examined for deviations in procedure task completion and/or navigation, in particular the execution of the Surgeon call sequence. Debrief comments were used to analyze unclear procedural steps and to discern any discrepancies between the procedure and generally accepted BME actions. The sequence followed by BME participants differed considerably from the sequence intended by the procedure. Common deviations included the call sequence used to contact Surgeon, the content of BME and crew interaction and the gathering of pertinent console resources. Differing perceptions of task priority and imprecise language seem to have caused multiple deviations from the procedure s intended sequence. The study generated 40 recommendations for the procedure, of which 34 are being implemented. These recommendations address improving the clarity of the instructions, identifying training considerations, expediting Surgeon contact, improving cues for anticipated flight control team communication and identifying missing console tools

The effects of the HEALTHY study intervention on middle school student dietary intakes

BackgroundThe HEALTHY study was designed to respond to the alarming trends in increasing rates of overweight, obesity, and type 2 diabetes mellitus in youth. The objective of this analysis was to examine the effects of the HEALTHY study on student self-reported dietary intakes (energy, macronutrients and grams consumed of selected food groups).MethodsHEALTHY was a cluster-randomized study in 42 public middle schools. Students, n = 3908, self-reported dietary intake using the Block Kids Questionnaire. General linear mixed models were used to analyze differences in dietary intake at the end of the study between intervention and control schools.ResultsThe reported average daily fruit consumption was 10% higher at the end of the study in the intervention schools than in the control schools (138 g or approximately 2 servings versus 122 g, respectively, p = 0.0016). The reported water intake was approximately 2 fluid ounces higher in the intervention schools than in the control (483 g versus 429 g respectively; p = 0.008). There were no significant differences between intervention and control for mean intakes of energy, macronutrients, fiber, grains, vegetables, legumes, sweets, sweetened beverages, and higher- or lower-fat milk consumption.ConclusionThe HEALTHY study, a five-semester middle school-based intervention program that integrated multiple components in nutrition, physical education, behavior change, and social marketing-based communications, resulted in significant changes to student's reported fruit and water intake. Subsequent interventions need to go beyond the school environment to change diet behaviors that may affect weight status of children.Clinical Trials RegistrationNCT0045802

Effect of Nutrition Changes on Foods Selected by Students in a Middle School-based Diabetes Prevention Intervention Program; the HEALTHY Experience

BACKGOUNDThe HEALTHY primary prevention trial developed an integrated multi-component intervention program to moderate risk factors for type 2 diabetes in middle schools. The nutrition component aimed to improve the quality of foods and beverages served to students. Changes in the School Breakfast Program (SBP), National School Lunch Program (NSLP), and a la carte venues are compared to the experience of control schools.METHODSThe intervention was implemented in 21 middle schools from winter 2007 through spring 2009 (following a cohort of students from sixth through eighth grades); 21 schools acted as observed controls. The nutrition component targeted school food service environmental change. Data identifying foods and nutrients served (selected by students for consumption) were collected over a 20-day period at baseline and end of study. Analysis compared end of study values for intervention versus control schools.RESULTSIntervention schools more successfully limited dessert and snack food portion size in NSLP and a la carte and lowered fat content of foods served. Servings of high fiber grain-based foods and/or legumes were improved in SBP but not NSLP. Intervention and control schools eliminated &gt;1% fat milk and sugar added beverages in SBP, but intervention schools were more successful in NSLP and a la carte.CONCLUSIONThe HEALTHY program demonstrated significant changes in the nutritional quality of foods and beverages served in the SBP, NSLP, and a la carte venues, as part of an effort to decrease childhood obesity and support beneficial effects in some secondary HEALTHY study outcomes