Cambridge Hybrid Closed-Loop System in Very Young Children With Type 1 Diabetes Reduces Caregivers' Fear of Hypoglycemia and Improves Their Well-Being.

OBJECTIVE: To evaluate the impact of CamAPS FX hybrid closed-loop (HCL) automated insulin delivery in very young children with type 1 diabetes (T1D) on caregivers' well-being, fear of hypoglycemia, and sleepiness. RESEARCH DESIGN AND METHODS: We conducted a multinational, open-label, randomized crossover study. Children (age 1-7 years) with T1D received treatment for two 4-month periods in random order, comparing HCL with sensor augmented pump (control). At baseline and after each treatment period, caregivers were invited to complete World Health Organization-Five Well-Being Index, Hypoglycemia Fear Survey, and Epworth Sleepiness Scale questionnaires. RESULTS: Caregivers of 74 children (mean ± SD age 5 ± 2 years and baseline HbA1c 7.3 ± 0.7%; 42% female) participated. Results revealed significantly lower scores for hypoglycemia fear (P < 0.001) and higher scores for well-being (P < 0.001) after HCL treatment. A trend toward a reduction in sleepiness score was observed (P = 0.09). CONCLUSIONS: Our results suggest better well-being and less hypoglycemia fear in caregivers of very young children with T1D on CamAPS FX HCL.

Psychological Well-Being of Parents of Very Young Children With Type 1 Diabetes - Baseline Assessment.

Background: Type 1 diabetes in young children is a heavy parental burden. As part of pilot phase of the KIDSAP01 study, we conducted a baseline assessment in parents to study the association between hypoglycemia fear, parental well-being and child behavior. Methods: All parents were invited to fill in baseline questionnaires: hypoglycemia fear survey (HFS), WHO-5, Epworth Sleepiness Scale and Strength and Difficulties Questionnaire (SDQ). Results: 24 children (median age: 5-year, range 1-7 years, 63% male, mean diabetes duration: 3 ± 1.7 years) participated. 23/24 parents filled out the questionnaires. We found a higher score for the hypoglycemia fear behavior 33.9 ± 5.6 compared to hypoglycemia worry 34.6 ± 12.2. Median WHO-5 score was 16 (8 - 22) with poor well-being in two parents. Median daytime sleepiness score was high in five parents (>10). For six children a high total behavioral difficulty score (>16) was reported. Pro social behavior score was lower than normal in six children (<6). Parental well-being was negatively associated with HFS total (r = - 0.50, p <.05) and subscale scores (r = - 0.44, p <.05 for HFS-Worry and HFS-Behavior), child behavior (r = - 0.45, p = .05) and positively with child age and diabetes duration (r = 0.58, p <.01, r = 0.6, p <.01). HFS, parental well-being nor daytime sleepiness are associated with the HbA1c. Conclusion: Regular screening of parental well-being, hypoglycemia fear and child behavior should be part of routine care to target early intervention.

What's in a diagnosis: The effect of externalizing and internalizing students' behaviour on pre-service teachers' classroom management and interaction strategies.

BACKGROUND: All over the word, classrooms are getting more and more diverse and teachers are required to effectively manage these classes even when students have special education needs (SEN). AIMS: The study aimed to investigate classroom management strategies and interpersonal teacher behaviour in relation to students internalizing and externalizing behaviour, whereby we varied the diagnosis of special educational needs. SAMPLE: Two hundred and fifty-four German pre-service teachers (143 female) with a mean age of 26.04 years participated in the study. METHOD: Using an experimental between-subjects design, a fictitious student was described as exhibiting either internalizing or externalizing behaviour. Additionally, we varied whether the student was diagnosed as having SEN or not. The participants were asked to indicate which strategies they would apply and how they would interact with students. RESULTS: Results showed that teacher interaction in response to both students with internalizing and externalizing behaviour approached ideal interpersonal teacher behaviour (i.e. high level of cooperativeness with certain level of dominance), whereas pre-service teachers applied all classroom management strategies to minimize effects of student behaviour on learning time. Although pre-service teachers adapted their responses based on type of behaviour, they only made allowances for internalizing behaviour while their response to externalizing behaviour did not vary much as a function of a SEN diagnosis. CONCLUSIONS: Together, these findings highlight the importance of providing pre-service teachers with the pedagogical knowledge concerning effective classroom management and flexible use of strategies in response to diverse student needs in inclusive classrooms.

Measurement invariance of the Positive Gains Scale in families of children with and without disabilities.

BACKGROUND: Despite the high frequency of case-control studies in the developmental disability literature, there is a paucity of research establishing the measurement equivalence of instruments used, and particularly those relating to positive perceptions and experiences in family disability research. AIMS: The present study sought to establish measurement invariance for the Positive Gains Scale (PGS) across 1219 mothers of children with developmental disabilities, 234 mothers of children with spina bifida/hydrocephalus, and 157 mothers of children without disabilities. METHODS AND PROCEDURES: A three-step test for measurement invariance across the three groups was conducted using Multigroup Confirmatory Factor Analysis. OUTCOMES AND RESULTS: Loadings between the three groups were invariant, suggesting the criteria to assume metric invariance was met. However, the assumption of scalar invariance was not met, suggesting that item intercepts differed between the three groups. CONCLUSIONS AND IMPLICATIONS: Our findings suggest that the PGS cannot be meaningfully used to compare outcomes between mothers of children with developmental disabilities and other mothers. These findings may have wider implications for research utilising well-being measures to make comparisons with carers of children with developmental disabilities.

Pre- and In-Service Teachers' Attitudes Toward Students With Learning Difficulties and Challenging Behavior.

The implementation of inclusive policies is largely dependent on teachers' willingness to accommodate students with special educational needs (SEN) in mainstream classrooms, which is affected by their perceived competence and attitudes. This study investigated attitudes of pre- and in-service teachers toward students with two types of SEN: challenging behavior and learning difficulties. The three components of attitudes (affective, cognitive, and behavioral) were assessed using indirect and direct measures. Results revealed that teachers held negative implicit attitudes toward challenging behavior and learning difficulties, however, implicit attitudes did not vary as a function of the type of SEN. Ratings of the stereotypical dimensions warmth and competence and overall ratings of scholastic achievement were affected by professional status and type of SEN. Professional status, implicit attitudes, and stereotypical knowledge together explained 52 and 43% of the variance in teachers' ratings of academic proficiency for students with challenging behavior and learning difficulties, respectively. Results are interpreted within the theoretical framework and implications for teacher training are discussed.

Lower plasma insulin levels during overnight closed-loop in school children with type 1 diabetes: Potential advantage? A randomized cross-over trial.

BACKGROUND: Studies have shown that overnight closed-loop insulin delivery can improve glucose control and reduce the risk of hypoglycemia and hence may improve metabolic outcomes and reduce burden for children with type 1 diabetes and their families. However, research so far has not reported insulin levels while comparing closed-loop to open-loop insulin delivery in children. Therefore, in this study we obtained glucose levels as well as plasma insulin levels in children with type 1 diabetes to evaluate the efficacy of a model-based closed-loop algorithm compared to an open-loop administration. METHODS: Fifteen children with type 1 diabetes, 6-12 years, participated in this open-label single center study. We used a randomized cross over design in which we compared overnight closed-loop insulin delivery with sensor augmented pump therapy for two nights in both the hospital and at home (i.e., 1 night in-patient stay and at home per treatment condition). Only during the in-patient stay, hourly plasma insulin and blood glucose levels were assessed and are reported in this paper. RESULTS: Results of paired sample t-tests revealed that although plasma insulin levels were significantly lower during the closed-loop than in the open-loop (Mean difference 36.51 pmol/l; t(13) = 2.13, p = .03, effect size d = 0.57), blood glucose levels did not vary between conditions (mean difference 0.76 mmol/l; t(13) = 1.24, p = .12, d = 0.37). The administered dose of insulin was significantly lower during the closed-loop compared with the open-loop (mean difference 0.10 UI; t(12) = 2.45, p = .02, d = 0.68). CONCLUSIONS: Lower insulin doses were delivered in the closed-loop, resulting in lower plasma insulin levels, whereby glucose levels were not affected negatively. This suggests that the closed-loop administration is better targeted and hence could be more effective.

Teachers' Implicit Attitudes Toward Students From Different Social Groups: A Meta-Analysis.

Teachers' attitudes toward their students have been associated with differential teachers' expectations and, in turn, with students' educational pathways. Theories of social cognition can explain the link between attitudes and behavior. In this regard, the distinction between implicit and explicit attitudes is worth to be considered, whereby implicit attitudes are automatically activated when the attitude object is present and guide automatic behavior. In contrast, explicit attitudes infer deliberation and reflection, hence affecting controlled behavior. As teachers often are required to act immediately in situations that do not allow for thoughtful reflection due to time restraints, teachers' implicit attitudes concerning different student groups with shared characteristics, such as gender or ethnicity, may be especially important when considering teachers' behavior in relation to students' educational pathways. This notion is reflected by an increased interest in adopting implicit methodology in the educational domain. Over the last 10 years, several studies have been conducted in different countries, involving in- and pre-service teachers and investigating their attitudes toward different student groups. Estimates of effects have varied and may be affected by sampling bias. To systematically review and integrate data from different studies, this meta-analysis focuses on teachers' implicit attitudes. Following the systematic search of the database and initial screening, 43 articles were identified from which 22, describing 34 studies, were retained for the meta-analysis after further inspection. First analyses revealed an estimated average effect size of 0.56 for implicit attitudes in favor of non-marginalized groups. As there was a large extent of heterogeneity between studies, several moderator variables were investigated. Results showed that the employed implicit measure and stimulus materials as well as the student target group affected the effect sizes. Low or non-significant relationships were reported between implicit and explicit attitudes. Findings are discussed in terms of theory and future research.

Mixed stereotype content and attitudes toward students with special educational needs and their inclusion in regular schools in Luxembourg.

BACKGROUND: Students with special educational needs (SEN) remain one of the most socially excluded and vulnerable groups. To this extent, negative attitudes and stereotypes may impede their inclusion. Theoretical frameworks have suggested that stereotypes and attitudes elicit differential expectations and judgments, which in turn affect (social) behaviors. AIMS: In this study, we aimed to investigate the stereotypes and implicit attitudes held by a sample of Luxemburgish adults toward students with learning difficulties and challenging behavior. We also explored the adults' explicit attitudes towards inclusion. METHOD AND PROCEDURES: Participants (N = 103) completed an evaluative priming task and rated students on the stereotype dimensions of warmth and competence. In addition, they completed the German version of The Opinions Relative to Integration of Students with Disabilities questionnaire and provided demographic information. OUTCOMES AND RESULTS: Results showed differential stereotype content with respect to students with learning difficulties and challenging behavior. Results further indicated that participants' implicit attitudes toward both challenging behavior and learning difficulties were negative. By contrast, participants expressed positive attitudes towards inclusion. CONCLUSIONS AND IMPLICATIONS: The results of the current study contribute to the understanding of why some people accept, whereas others reject students with SEN. Understanding prevalent stereotypes and attitudes can inform the development of targeted interventions to promote and facilitate the social inclusion of students with SEN.

Can health indicators and psychosocial characteristics predict attrition in youths with overweight and obesity seeking ambulatory treatment? Data from a retrospective longitudinal study in a paediatric clinic in Luxembourg.

OBJECTIVES: The current study aimed to identify factors that could predict attrition in youths starting ambulatory treatment to control or lose weight. DESIGN: Retrospective longitudinal study. SETTING: Paediatric clinic: ambulatory treatment programme. PATIENTS AND MEASURES: A youth sample (n=191; 89 boys; aged 7-17 years) completed measures of demographic characteristics, and health and psychosocial traits before starting an ambulatory weight management programme. Anthropometric and biological markers related to obesity were also obtained. Tests of mean differences and regression analyses were used to investigate the relationship between these variables and attrition after 1 year. RESULTS: The χ2and t test results showed both psychosocial and health indicators differentiated between participants who continued attending the treatment programme and those who dropped out. More specifically, youths that dropped out of treatment were significantly older, had higher body mass index z scores, higher levels of insulin, triglycerides and HOMA-IR, reported poorer health, had more conduct problems and were more dissatisfied with themselves and their bodies before starting treatment. Results of regression analyses revealed that weight status (anthropometric and biological markers), age and body dissatisfaction predicted attrition (overall prediction success 73%; prediction success for continued attendance 90/91%; prediction success for dropouts 42/44%). CONCLUSION: Attrition, but especially the continued attendance in treatment, can be successfully predicted by age, weight status and body dissatisfaction. For patients who present with one or more risk factors, careful consideration is needed to decide which (combination of) inpatient or outpatient programme may facilitate prolonged engagement of the patient and hence may be most effective in establishing weight loss.

Empathy in preschool children: the development of the Southampton Test of Empathy for Preschoolers (STEP).

In this study, we investigated a new instrument: the Southampton Test of Empathy for Preschoolers (STEP). The test incorporated 8 video vignettes of children in emotional scenarios, assessing a child's ability to understand (STEP-UND) and share (STEP-SHA) in the emotional experience of a story protagonist. Each vignette included 4 emotions (angry, happy, fearful, sad) that reflected emotion judgments based on the protagonist's facial expression, situation, verbal cues, and desire. The STEP was administered to 39 preschool children, and internal reliability, concurrent validity, and construct validity were addressed. The results showed good internal consistency. They also highlighted moderate concurrent validity with parent-rated empathy, a measure of facial indices, and construct validity with teacher-rated prosocial behavior.

Physiological correlates of intellectual function in children with sickle cell disease: hypoxaemia, hyperaemia and brain infarction.

Lowered intelligence relative to controls is evident by mid-childhood in children with sickle cell disease. There is consensus that brain infarct contributes to this deficit, but the subtle lowering of IQ in children with normal MRI scans might be accounted for by chronic systemic complications leading to insufficient oxygen delivery to the brain. We investigated the relationship between daytime oxyhaemoglobin saturation (SpO2), cerebral blood flow velocity (CBFV) and intellectual function (IQ) using path-analysis in 30 adolescents with sickle cell disease (mean age 17.4 years, SD 4.2). Initial analyses revealed that the association between SpO2 and Full Scale IQ (FSIQ) was fully mediated by increased CBFV, whereby SpO2 was negatively correlated with CBFV and CBFV was negatively correlated with FSIQ, i.e. decreases in oxygen saturation are associated with increases in velocity, and increased velocity is associated with lowered IQ scores. The mediated relationship suggests that lowered IQ may be a function of abnormal oxygen delivery to the brain. Further analyses showed that the association between CBFV and IQ was significant for verbal but not for performance IQ. The pathophysiology characteristic of SCD can interfere with brain function and constrain intellectual development, even in the absence of an infarct. This supports the hypothesis that lowered intellectual function is partly explained by chronic hypoxia, and has wider implications for our understanding of SCD pathophysiology.